Utilization Manager Jobs Near Me

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

SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations ...

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

SUMMARY The Utilization Management Specialist is responsible for coordinating and managing all prior authorization activities for clinical services across multiple Medicaid Managed Care Organizations ...

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

Conducts utilization reviews of behavioral health cases to determine medical necessity ... Assists with retrospective reviews and denial management to maintain appropriate and cost-effective ...

Conducts utilization reviews of behavioral health cases to determine medical necessity ... Assists with retrospective reviews and denial management to maintain appropriate and cost-effective ...

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 ...

The Utilization Review Specialist manages daily operations, which include supervising the staff performing benefit enrollments and utilization management activities. The Utilization Review Specialist ...

Participates as an active management member of the Mount Carmel Health Plan representing the Utilization Review Department in collaboratively meeting operational, budget, and strategic planning goals ...

Performs utilization review and case management support on complex members * Provides support over the phone, through messaging and video to support chronic disease management * Offers peer-to-peer ...

Care Review Clinician Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at ...

Drive fleet utilization and process improvements through business analytics, identifying trends ... Direct and manage 3rd party vendors related to asset tracking, driver and equipment files and ...

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

Drive fleet utilization and process improvements * Improve fleet asset use (tractors and trailers ... Direct and manage 3rd party vendors related to asset tracking, driver and equipment files and ...

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 ...

Directing all activities in a clinical focused area of expertise (Utilization Management (UM) or Quality Improvement) to ensure alignment with the department's population health strategies, health ...

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

Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior ...

Serve as the local access and reimbursement expert for the assigned geography, monitoring payer policy, formulary coverage, utilization management requirements, pharmacy access pathways, prior ...