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BEHAVIORAL HEALTH UTILIZATION MANAGEMENT NURSE

Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request. Collaborate with appropriate parties to apply the...

CompanyUnited Claim Solutions Llc
AddressRemote
CategoryHuman Resources
Salary$60.5K - $76.6K a year
Job typeFull-time
Date Posted 4 weeks ago See detail

Behavioral Health Utilization Management Nurse

United Claim Solutions Llc

Remote

$60.5K - $76.6K a year

Conduct timely reviews of UM activities, including prospective, concurrent, and retrospective reviews and apply to summary plan documents or other resources related to the request. Collaborate with appropriate parties to apply the...

4 weeks ago seen See more...

Utilization Manager - Remote

Gentiva

Mooresville, NC

$76.8K - $97.3K a year

Experienced in hospice branch leadership and management. Knowledge of hospice rules, regulations, and Conditions of Participation Proven analytic skills, including mining, evaluation, analysis, and visualization Demonstrated exper...

4 weeks ago seen See more...

Utilization Management Specialist

Group1001

Park Ridge, IL

Performs prospective, initial, concurrent, and retrospective reviews for all requested services to include but not limited to the following: inpatient admissions, concurrent reviews, discharges, durable medical equipment (DME), Pa...

4 weeks ago seen See more...

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...

4 weeks ago seen See more...

Utilization Management Consultant

Genesis Healthcare System

Zanesville, OH

In addition the position provides case review information to third party payers, assists in the denial and appeals process, and assesses quality, identifying and reporting potential risk management issues. Living the Genesis Missi...

4 weeks ago seen See more...

Utilization Management Specialist

Allmed Staffing Inc

Everett, WA

Initiate Referral Authorizations. Acquires and maintain a working knowledge of contracted health plans agreements and related insurance products. Gathers information from relevant sources for processing referrals and authorization...

4 weeks ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Sacramento, CA

$29.50 - $63.75 an hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical informati...

4 weeks ago seen See more...

LVN- Utilization Management

Ks Management Services, Llc

Pearland, TX

$54,186 - $66,936 a year

Medical, Vision, and Dental. Tuition Reimbursement. Company Matching 401K. Employee Reward and Recognition Program. Paid time off for vacation, sick, and holidays. Employee Assistance Program. Continuing Medical Education allowanc...

4 weeks ago seen See more...

Utilization Management Nurse

Cottingham & Butler

Dubuque, IA

$61.4K - $77.8K a year

We are looking for a nurse just like you - a nurse that thrives in a fast-paced environment, enjoys making a difference for patients, but that and prefers working in a professional office setting with daytime office hours and week...

4 weeks ago seen See more...

Medical Director, Utilization Management - Remote (Missouri)

Optum

Kansas City, MO

$267K - $338K a year

Participate in telephonic outreach for collaboration with treating providers. This will include discussion of evidence - based guidelines, opportunities to close clinical quality / service gaps, and care plan changes that can impa...

4 weeks ago seen See more...

Utilization Management Nurse 2

Humana

Boise, ID

The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge an...

a month ago seen See more...

Utilization Management Representative II

Elevance Health

Manchester, NH

$15.56 - $24.58 an hour

Job Family: Customer Care Type: Full time. Date Posted: Mar 08, 2024 Anticipated End Date: Apr 26, 2024 Reference: JR108675. Responsible for providing technical guidance to UM Reps who handle correspondence. Assist callers with is...

a month ago seen See more...

Utilization Management Coordinator

Astrana Health

Monterey Park, CA

Comply with UM policies and procedures. Annual review of selected UM policies. Read and understand NMM UM Customer Service Policy and Procedures. Answer incoming calls from providers both contracted and non-contracted. (Average 60...

a month ago seen See more...

Remote Utilization Management (UM) Coordinator (Long-Term Temporary w/ Medical Benefits)

Alignment Healthcare

Lake Forest, CA

Pacific Time: 8am - 5pm. Mountain Time: 9am - 6pm. Central Time: 10am - 7pm. Eastern Time: 11am - 8pm. Monitor fax folders. Verify eligibility and / or benefit coverage for requested services. Enter pre-service requests / authoriz...

a month ago seen See more...

Utilization Management Nurse Consultant

Cvs Health

Charleston, WV

$26.01 - $56.13 an hour

Must have active, current and unrestricted RN licensure in state of residence. 3+ years of clinical experience. Position requires proficiency with computer skills which includes navigating multiple systems. Ability to work in a fa...

a month ago seen See more...

ISNP Utilization Management Nurse

Longevity Health Plan

United States

$79,000 - $96,000 a year

Receives requests for authorization of services, including inpatient hospital admissions, outpatient and/or inpatient elective surgery, and referrals for specialty physician consultation with non participating physician offices....

a month ago seen See more...

CarePlus - Weekend Utilization Management Nurse, RN - Remote- Florida

Humana

Lorida, FL

Coordinates and communicates with providers, members, or other parties to facilitate optimal care and treatment. Understands department, segment, and organizational strategy and operating objectives, including their linkages to re...

a month ago seen See more...

Utilization Management LPN

Allegiance Benefit Plan Mgmt.

Remote

$24.75 an hour

Able to initiate phone calls requesting information for admissions and continued stay reviews. Evaluates and authorizes the medical necessity of Services requested. utilizing, but not limited to the below criteria:. American Socie...

a month ago seen See more...

Utilization Management Denial Review Nurse - LVN

Ucla Health

Los Angeles, CA

$61,400 - $121,400 a year

DescriptionQualificationsWere seeking an exceptionally gifted, self-motivated leader with: * Current CA LVN licensure required * Two or more years of utilization review/Utilization Management experience in an HMO, MSO, IPA, or he...

a month ago seen See more...

Utilization Management Supervisor (Dental Insurance)

Liberty Dental Plan

Tustin, CA

$58,760 - $76,388 a year

Assist with recruiting, hiring, evaluation, and selection. Update job descriptions and develop performance expectations. Supervise employee and team performance. Train and provide adequate coaching, counseling, and motivation; ide...

a month ago seen See more...

Utilization Management Medical Director - WellMed Medical Group

Optum

San Antonio, TX

$122K - $154K a year

Assists in development and maintaining an efficient UM program to meet the needs of the health plan members and commensurate with company values. Educates primary care physicians regarding systems, structures, processes and outcom...

a month ago seen See more...

Utilization Management Nurse Consultant Afternoon Shift

Cvs Health

Columbus, OH

$29.10 - $62.31 an hour

Weekend/holiday coverage will occasionally be required. This candidate will utilize clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Utilizes clinical experience an...

a month ago seen See more...

Utilization Management Coordinator

Rochester Regional Health

Rochester, NY

$21.50 - $31.60 an hour

Pension Plan Retirement Plan Comprehensive Benefits Package Tuition Reimbursement Benefits Effective Date of Hire Same Day Pay through Daily Pay 3 years of Utilization Management experience preferred 3 years of acute hospital care...

a month ago seen See more...

Utilization Management Manager Regulatory Operations

Oscar Health

Tempe, AZ

$97,200 - $127,575 a year

Be the example of the continuous improvement mindset, providing direction and influence, while demonstrating actual results of organizational behavior change in this area. Demonstrate the proper approach with implementation of Con...

a month ago seen See more...

Utilization Management Clinician I - RN or LPN

Community Health Plan Of Washington

Seattle, WA

Strive to apply an equity lens to all our work.. Reduce health disparities.. Become an anti-racist organization.. Create an equitable work environment.. Have a bachelors degree in a relevant field or an equivalent combination...

a month ago seen See more...

Senior Utilization Management Assistant

Providence

Anaheim, CA

$22.93 - $35.77 an hour

Associate's Degree in Health care, business or related field, preferred or. Bachelors Degree in Health care, business or related field, preferred or equivalent education/experience....

a month ago seen See more...

RN Utilization Manager - Full-time - OLGMC - Utilization Review

Ochsner Health System

Lafayette, LA

$71.6K - $90.6K a year

Must have computer skills and dexterity required for data entry and retrieval of patient information. Must be proficient with Windows-style applications and keyboard. Effective verbal and written communication skills and the abili...

a month ago seen See more...

Utilization Management Supervisor

Hill Physicians Medical Group

San Ramon, CA

$110,000 - $120,000 a year

Provide clinical expertise, guidance and supervision to the Authorizations staff including clinical and non-clinical staff. Lead by example and act as a resource to staff by resolving clinical and benefit issues. Manage staff prod...

a month ago seen See more...

Vice President Clinical Service - Utilization Management & Appeals

Cambia Health Solutions

Renton, WA

Provides leadership in developing, implementing, and communicating short and long-range plans, goals and objectives for the function. Aligns team goals with the organization's vision and strategy. Develops strategies and tactics t...

a month ago seen See more...

Vice President Clinical Service - Utilization Management & Appeals

Cambia Health

Boise, ID

Provides leadership in developing, implementing, and communicating short and long-range plans, goals and objectives for the function. Aligns team goals with the organization's vision and strategy. Develops strategies and tactics t...

a month ago seen See more...

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What are the top cities open Utilization Manager jobs?

There are open Utilization Manager jobs in several cities including Los Angeles, Yakima, Honolulu, Jackson, Waterloo, Saint Clairsville, Chicago, Somerset, Latrobe, Kapolei, Albuquerque, Washington,

What companies are hiring for Utilization Manager jobs?

The top companies hiring now for Utilization Manager jobs are Acacia, Acacia Network, Clinica Romero, Emory Healthcare, PROMESA R.H.C.F., Southeast Healthcare, Spectrum Healthcare Resources, Spectrum Healthcare Resources - 3.3,

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