- Hawaii Pacific Health (Honolulu, HI)
- …and training, as well as internal peer equity. **Position** Specialist , Managed Care - Utilization Mgmt **Category** Administrative **Employment Type** ... As the Specialist , you will be responsible for providing comprehensive managed care information related to Hawai'i Pacific Health contracted health plans,… more
- LA Care Health Plan (Los Angeles, CA)
- … Utilization Management/Case Management experience in a hospital or HMO setting. Preferred: Managed Care experience performing UM and CM at a medical group or ... Utilization Management Nurse Specialist LVN II...At least 4 years of experience in a patient care setting and/or combination in utilization management,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job...experience in a hospital or HMO setting . Preferred: Managed Care experience performing UM and CM at ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- LA Care Health Plan (Los Angeles, CA)
- Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department: Managed Long Term Services and Supports Location: Los ... Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical...and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).… more
- Hackensack Meridian Health (Hackensack, NJ)
- …& levels of appeal iv. Root cause analysis & trends v. Participation in Managed Care Contracting & distribution of contract terms where appropriate 7. ... **Overview** The Senior Utilization Review Specialist collaborates with the...Management and Organizational Strategy a. Development & implementation of Utilization Management strategies to assure appropriate health care… more
- LifePoint Health (Athens, TN)
- …seeking talent to fill the position of Intake Nurse and Utilization Specialist for ourGeroPsychDepartment.This job is permanent,full-time. Core competencies ... patients from otherfacilities. * Documentspayer interactions on assigned casesregardingauthorizations with managed care review agencies, in the manner required… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- LA Care Health Plan (Los Angeles, CA)
- …internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services, ... Enhanced Care Management Clinical Specialist II Job...care professionals in a hospital, medical group or managed care setting, such as a health… more
- ManpowerGroup (Rancho Cucamonga, CA)
- …GED required **Key Qualifications** + Requires knowledge of ICD-9/10 and CPT codes + Managed Care or physician office a must + Skilled in computer applications, ... **Job Title: Utilization Management Outpatient** **Duration: 6 months** **Location: Rancho...month)** **Pay rate: $23.98/hr.** **We are looking for an Utilization Management Outpatient** **to join one of our Fortune… more
- Houston Methodist (Houston, TX)
- …the designated area(s) of responsibility or populations served. The Pharmacy Clinical Specialist position supports the delivery of pharmacy managed protocols, ... At Houston Methodist, the Pharmacy Clinical Specialist position is responsible for performing advanced clinical pharmacy duties enabling the delivery of optimal… more