Utilization Manager Jobs Near Me

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

For billing and hospitalization utilization review purposes, the reviewer will identify and certify ... Maintain compliancy with regulation changes affecting utilization management. PositionRequirements ...

I Am Boundless is hiring for a Utilization Management (UM) Clinical Specialist ! Boundless is a non-profit organization specializing in assisting individuals with I/DD and has been serving Ohio for ...

Well versed in Utilization Management - Must be able to determine elective vs urgent request with Prior Authorization Review * Provider Claims, Appeals and Denials - certain services require prior ...

Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work ... Reports utilization review progress to leadership and ensures compliance with contractual standards ...

Manages incoming and outgoing telephones, emails, and faxes. Monitors and completes multiple work ... Reports utilization review progress to leadership and ensures compliance with contractual standards ...

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

Drug Utilization Review Pharmacist - Ensure Safe and Effective Use of Medications A confidential managed care organization is seeking a skilled Drug Utilization Review (DUR) Pharmacist to support ...

Formulary & Utilization Management Strategy & Development: May lead Highmark's evidence-based medicine drug evaluation program supporting Highmark's formulary and utilization management (UM) and/or ...

The job duties require the utilization of clinical knowledge to interpret and apply medical ... Manages escalation processes to administration regarding the need to cancel or reschedule elective ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

LCDC III or LSW is acceptable if working in the Substance Abuse Program.  Prefer 2 years utilization review, discharge planning, case management or medical social work experience.  Strong ...

Utilization review, prior authorization, or managed care experience preferred. * Active OH RN Licensure * Experienced with either Interqual or Milliman Licenses/Certifications: Current RN, required.

Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review ...

Communicate with insurance providers, case managers, and clinical staff regarding coverage and updates * Monitor utilization of services to ensure compliance with payer guidelines and facility ...

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members ...

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...