Utilization Manager jobs
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VICE PRESIDENT OF UTILIZATION MANAGEMENT
8 years of management experience in a health-related field. 10 years of experience in a Utilization Management position. Hospital based clinical experience required. Experience analyzing and using data to drive improvement activit...
| Company | Consilium Partners360, Llc |
|---|---|
| Address | Remote |
| Category | Human Resources |
| Salary | $200,000 - $230,000 a year |
| Job type | Full-time |
| Date Posted | 3 weeks ago See detail |
Vice President of Utilization Management
Consilium Partners360, Llc
Remote
$200,000 - $230,000 a year
8 years of management experience in a health-related field. 10 years of experience in a Utilization Management position. Hospital based clinical experience required. Experience analyzing and using data to drive improvement activit...
3 weeks ago seen See more...
- View all Consilium Partners360, Llc jobs
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...
3 weeks ago seen See more...
- View all Humana jobs - jobs in Louisiana State
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...
3 weeks ago seen See more...
- View all Humana jobs - jobs in Virginia State
Utilization Management Reviewer I
Crawford & Company
United States
$75.3K - $95.3K a year
Uses clinical RN or RPT training and knowledge to render authorization decisions of medical necessity of requested medical treatment. Analyzes medical information and applies clinical knowledge and established criterion to facilit...
3 weeks ago seen See more...
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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...
3 weeks ago seen See more...
- View all Elevance Health jobs - jobs in CHICAGO, IL
Utilization Management Nurse
One Senior Care
Erie, PA
9 Paid Holidays. 3 Weeks and 1 Day of Paid Time Off Accrued from the Date of Hire for Full-Time Employees. Annual Pay increases for Performance. Medical, Dental, & Vision. Free Life and AD&D Insurance Plan. Health Savings and Flex...
3 weeks ago seen See more...
- View all One Senior Care jobs - jobs in Erie, PA
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...
3 weeks ago seen See more...
- View all Uva Health jobs - jobs in Charlottesville, VA
Utilization Management LVN Nurse - Remote
Conifer Value
Frisco, TX
$27.30 - $40.95 an hour
Responsible for providing timely referral determination by accurate:Usage of the Milliman Care Guidelines.Identification of referrals to the medical director for review.Appropriate letter language (i.e. denials).Appropriate sele...
3 weeks ago seen See more...
- View all Conifer Value jobs - jobs in Frisco, TX
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...
3 weeks ago seen See more...
- View all Wexford Health jobs - jobs in Sylvania, PA
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...
3 weeks ago seen See more...
- View all Elevance Health jobs - jobs in Norfolk, VA
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...
3 weeks 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...
3 weeks ago seen See more...
- View all Solis Health Plans jobs - jobs in Miami, FL
Case Manager Utilization RN, 32/hr Day
Kaiser Permanente
Los Angeles, CA
Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...
5 days ago seen See more...
- View all Kaiser Permanente jobs - jobs in Los Angeles, CA
Case Management Utilization RN, 20/hr Day
Kaiser Permanente
San Diego, CA
Plans, develops, assesses and evaluates care provided to members. Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of app...
5 days ago seen See more...
- View all Kaiser Permanente jobs - jobs in San Diego, CA
Behavioral Health Utilization Management Coord, PRN
Piedmont Healthcare
Macon, GA
JOB PURPOSE:The purpose of this position is to ensure that admitted patients have the appropriate level of care,patient status, authorization status, plan of care and meet medical necessity for the Behavioral Healthservices. Thi...
3 weeks ago seen See more...
- View all Piedmont Healthcare jobs - jobs in Macon, GA
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...
3 weeks 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...
3 weeks 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...
3 weeks ago seen See more...
- View all Elevance Health jobs - jobs in PALO ALTO, CA
RN Utilization Management Nurse - Remote in OR
Unitedhealth Group
Portland, OR
Consistently exhibits behavior and communication skills that demonstrate Optum's commitment to superior customer service, including quality, care and concern with each and every internal and external customer. Perform all function...
4 weeks ago seen See more...
- View all Unitedhealth Group jobs - jobs in Portland, OR
RN Supervisor Utilization Management
Commonspirit Health
Rancho Cordova, CA
Under general supervision this position is responsible for coordinating the daily operations of the UM Pre-Authorization team in order to ensure requests are processed in a consistent and timely manner while observing regulatory g...
4 weeks ago seen See more...
Care Coordinator - Utilization Management
Villagecare Of New York
New York, NY
$25.01 - $28.14 an hour
Respond to inquiries from members and providers regarding health insurance, benefits, eligibility and authorization. Initiate contact with care management team, provider relations department and external providers to meet member's...
4 weeks ago seen See more...
- View all Villagecare Of New York jobs - jobs in New York, NY
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...
4 weeks 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...
4 weeks ago seen See more...
Utilization Management Clinical Consultant
Cvs Health
Baton Rouge, LA
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence based care an...
4 weeks ago seen See more...
- View all Cvs Health jobs - jobs in Baton Rouge, LA
Director of Utilization Management (UM) and Performance Improvement (PI) in Psychiatry
Jamaica Hospital Medical Center
Richmond Hill, NY
Up to $135,000 a year
Utilization Management (UM):. Develop and implement UM strategies to ensure appropriate utilization of psychiatric services, including inpatient, outpatient, and emergency psychiatric care. Oversee the utilization review process,...
4 weeks 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...
4 weeks ago seen See more...
- View all Guthrie jobs - jobs in Sayre, PA
Registered Nurse - Utilization Manager
Erp International
Little Rock Air Force Base, AR
Founded in 2006, ERP is headquartered in Laurel, MD and maintains satellite offices in Montgomery, AL and San Antonio, TX - plus project locations nationwide. Performs prospective, concurrent, and/or retrospective utilization revi...
4 weeks ago seen See more...
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...
4 weeks ago seen See more...
- View all Fallon Health jobs - jobs in Worcester, MA
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...
4 weeks ago seen See more...
- View all Omg Technology jobs - jobs in Long Beach, CA
Sr Utilization Management Nurse RN Onsite/Remote- MA
Optum
Boston, MA
$93.3K - $118K a year
Audit entire medical record for accuracy of the coding on the MMQ to support payment to the nursing facility. Answer patient questions regarding care (medication, treatment) and benefits. Discuss Patient Care specifics with peers...
4 weeks ago seen See more...
- View all Optum jobs - jobs in Boston, MA
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