Contract Utilization Management jobs
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UTILIZATION MANAGEMENT SPECIALIST
Analyze electronic medical records. Focus on evaluating the utilization of healthcare services, treatments, and procedures. Utilize retrospective reviews and other UM tools to identify opportunities for improvement and optimize pa...
| Company | Kaizen Clinical Partners, Inc. |
|---|---|
| Address | McAllen, TX |
| Category | Human Resources |
| Salary | $44.9K - $56.8K a year |
| Job type | Full-time |
| Date Posted | 3 days ago See detail |
Utilization Management Specialist
Kaizen Clinical Partners, Inc.
McAllen, TX
$44.9K - $56.8K a year
Analyze electronic medical records. Focus on evaluating the utilization of healthcare services, treatments, and procedures. Utilize retrospective reviews and other UM tools to identify opportunities for improvement and optimize pa...
3 days ago seen See more...
- View all - jobs in McAllen, TX
Utilization Management Representative II
Elevance Health
Denver, CO
Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...
6 days ago seen See more...
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Utilization Management Representative II
Elevance Health
CHICAGO, IL
Managing incoming calls or incoming post services claims work. . Determining contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post-service req...
7 days ago seen See more...
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Utilization Management Supervisor Non Clinical
Adventhealth Tampa
Tampa, FL
$24.60 - $36.90 an hour
Paid Days Off from Day One. Student Loan Repayment Program. Career Development. Whole Person Wellbeing Resources. Mental Health Resources and Support. AdventHealth Pepin Heart Institute, known across the country for its advances i...
a week ago seen See more...
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Utilization Management Nurse - Dallas, TX
Adecco
Dallas, TX
$ 80000 - $ 90000 / Year
Five years inpatient clinical nursing experience in an acute care hospital setting required.. Minimum of two years Utilization Management acute care setting experience required. . Minimum of one-year drafting and submitting reco...
3 weeks ago seen See more...
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Nurse IV (Utilization Management)
Department Of Veterans Affairs
Vancouver, WA
Competitive
U.S. Citizenship; non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. All applicants tentatively selected for VA employment in a testing designated position are su...
4 weeks ago seen See more...
Texas Institute Utilization Management Nurse -Dallas
Adecco
Dallas, TX
$ 80000 - $ 90000 / Year
Five years inpatient clinical nursing experience in an acute care hospital setting required. Minimum of two years Utilization Management acute care setting experience required. Minimum of one year drafting an...
4 weeks ago seen See more...
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Utilization Management Coordinator
Yoh, A Day & Zimmermann Company
Alameda, CA
One (1) year of Managed Care experience (HMO or IPA) strongly preferred. Ability to work from home M-F, 8am-5pm PT. Support clinical staff through completion of the administrative and nonclinical coordinator functional components...
4 weeks ago seen See more...
Utilization Management RN - Remote
Mitchell Martin
New York, NY
Our client located in New York, NY is looking for an Utilization Management RNType: ContractSchedule: M-F 8a-5p Location: RemoteThe Registered Nurse will perform clinical and operational processes related to transition / coordinat...
4 weeks ago seen See more...
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Utilization Manager Needed in Dallas, TX
Adecco
Dallas, TX
$ 80000 - $ 90000 / Year
Mandatory five years of inpatient clinical nursing experience within an acute care hospital setting. Minimum of two years' experience in Utilization Management within an acute care setting. Proficiency with drafting and submitting...
4 weeks ago seen See more...
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Registered Nurse (RN), Utilization Management - Adolescent Psych - PRN - Now Hiring
Denver Health
Denver, CO
$34.45 - $51.68 per hour
Works closely with other DHHA staff members including providers, nursing, insurance personnel, scheduling staff, staff in other departments.. (20%). Participates in care planning and discharge planning with the staff, providers an...
a month ago seen See more...
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Utilization Management Coordinator
Sanford Health
United States
We're proud to offer many development and advancement opportunities to our nearly 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint. Monday - Friday 8:30 am to 4 pm...
a month ago seen See more...
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Utilization Management Clinical Processor
Avesis, Incorporated
Remote
$18.33 - $28.67 an hour
- determining cases of recommended treatment in accordance with Avesis UM procedural guidelines or refers the case to Clinical Director or consultant for professional review of clinical denials. Understands and upholds Avesis pol...
a month ago seen See more...
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Utilization Management Administrative Support Coordinator
Humana
Louisiana, United States
$40.9K - $51.7K a year
Decisions are typically focus on interpretation of area/department policy and methods for completing assignments. Works within defined parameters to identify work expectations and quality standards, but has some latitude over prio...
a month ago seen See more...
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Associate Director, Utilization Management Nursing - VA Medicaid
Humana
Virginia, United States
$102,200 - $128,000 a year
Serves as a liaison between Humana and the Commonwealth regarding prior authorization reviews, prepayment retrospective reviews, and any additional Utilization Management functions. Coordinates with the Clinical Leadership team to...
2 months ago seen See more...
- View all Humana jobs - jobs in Virginia State
Utilization Management Representative
Elevance Health
CHICAGO, IL
Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in CHICAGO, IL
Registered Nurse (RN) - Utilization Management (Remote)
Uva Health
Charlottesville, VA
$71,988.80 - $115,190.40 a year
They collaborate with physicians and other members of the healthcare team to promote and adhere to regulatory compliance. All Utilization Management activities are performed in accordance with the mission vision and values of UVA...
2 months ago seen See more...
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Utilization Management Registered Nurse
Wexford Health
Sylvania, PA
Work with patients and providers for the patients best interests by helping to ensure appropriate care and maximizing clients medical benefits; Review clinical information provided by the Hospital Utilization Management Departm...
2 months ago seen See more...
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Utilization Management Representative I
Elevance Health
Norfolk, VA
$14.97 - $26.94 an hour
Job Family: CUS > Care Support Type: Full time. Date Posted: Mar 29, 2024 Anticipated End Date: Apr 12, 2024 Reference: JR110000. Managing incoming calls or incoming post services claims work. Determines contract and benefit eligi...
2 months ago seen See more...
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Utilization Management Clinician - Behavioral Health
Pacificsource Health Plans
Salem, OR
$88K - $111K a year
Collect and assess member information pertinent to members history, condition, and functional abilities in order to promote wellness, appropriate utilization, and cost-effective care and services. Coordinate necessary resources t...
2 months ago seen See more...
- View all Pacificsource Health Plans jobs - jobs in Salem, OR
Utilization Management Nurse
Solis Health Plans
Miami, FL
Conduct concurrent and retrospective utilization review for inpatient, observation or SNF services. Conducts clinical reviews of proposed services against appropriate criteria/guidelines to determine medical necessity, benefit eli...
2 months ago seen See more...
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Utilization Management Representative III
Elevance Health
NORFOLK, VA
Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inp...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in NORFOLK, VA
Utilization Management Representative III
Elevance Health
NORFOLK, VA
Responsible for providing technical guidance to UM Reps who handle correspondence and assist callers with issues concerning contract and benefit eligibility for requested continuing pre-certification and prior authorization of inp...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in NORFOLK, VA
Utilization Management Representative II
Elevance Health
PALO ALTO, CA
Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in PALO ALTO, CA
Utilization Management Representative I
Elevance Health
NORFOLK, VA
Managing incoming calls or incoming post services claims work. . Determines contract and benefit eligibility; provides authorization for inpatient admission, outpatient precertification, prior authorization, and post service requ...
2 months ago seen See more...
- View all Elevance Health jobs - jobs in NORFOLK, VA
Utilization Management Clinical Registered Nurse (RN) - Clinic
Texas Children's Hospital
Bellaire, TX
In addition, discharge planning and provider education are major components of this process.Think you've got what it takes?Responsibilities* Analyze submitted information including clinical assessments, treatment plan, regulatory...
2 months ago seen See more...
RN Utilization Management - Per Diem
Guthrie
Sayre, PA
Coordinate and facilitate correct identification of patient status.Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to ensure that all hospitalized patients have the correct admissi...
2 months ago seen See more...
- View all Guthrie jobs - jobs in Sayre, PA
Utilization Management RN
Fallon Health
Worcester, MA
Obtain clinical, functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with other health care professionals, member and/or f...
2 months ago seen See more...
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Care Review Processor with Utilization Review/Managed Care Exp. (REMOTE - CA)
Omg Technology
Long Beach, CA
Provide computer entries of authorization requests/provider inquiries by phone, mail, or fax. Including: Verify member eligibility and benefits. Determine provider contracting status and appropriateness. Determine diagnosis and tr...
2 months ago seen See more...
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Utilization Management Nurse RN
Optum
Bangor, ME
$58,300 - $114,300 a year
Validates authorization for all procedure / bedded patients UM pre-admission. Ensuring acquisition of pre-certification authorization, urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acut...
2 months ago seen See more...
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