- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Specialist, you will be responsible for: + Managing service requests and potential quality ... to all stakeholders. + Working closely with medical director, utilization management and quality review team to ensure that all cases are handled… more
- UCLA Health (Los Angeles, CA)
- Description As the Utilization Management & Quality Review Nurse, you will be responsible for: + Ensuring appropriate, cost-effective, and high- ... quality care for New Century Health Plan members + Conducting utilization management (UM) activities in accordance with health plan policies and regulatory… more
- CaroMont Health (Gastonia, NC)
- …in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management preferred. ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of ... budgeted targets. + Provides medical/psychiatric leadership/consultation to Provider Relations, Medical Utilization Management , and Quality Management … more
- Kepro (AR)
- … of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality review ... + 2+ years of experience in a behavioral health setting, conducting behavioral health utilization reviews or behavioral health case management . + Ability to work… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in ... advisor and external review organizations to ensure quality outcomes, patient throughput, and appropriate resource utilization...in an acute healthcare setting required, preferably with case management , utilization review or closely… more
- Regis HR Group (Miami, FL)
- …needed. + Interfaces with the provider community regarding medical care management , utilization review and quality improvement issues and concerns. + ... managed care. + Experience in the development and management of utilization review and quality improvement programs. + Outstanding oral and written… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …a state agency this class is accountable for coordinating a utilization review program which promotes effective cost recovery, quality of care and/or ... Utilization Review Nurse Coordinator (40 Hour)...+ Coordinates workflow and determines priorities to assure highest quality of care with efficient utilization of… more
- Kelsey-Seybold Clinic (Houston, TX)
- …(ASC). The Utilization Review Specialist (LVN) will support the Utilization Review quality assurance initiatives including mock audits to ensure ... Review Specialist (LVN)** **Location: Pearland Administrative Office** **Department:** ** Utilization Management ** **Job Type: Full Time** **Salary Range:… more
- Sutter Health (Berkeley, CA)
- …managers, clinical nursing staff and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and ... systems for the appeal/denial process, tracks and trends data, and coordinates utilization management activities for the assigned area. Collaborates with… more