- Sonora Quest (Sterling, CO)
- …the appropriate use of supplies and materials and assists with inventory management . Ensures efficient utilization of reagents and supplies. Recognizes and ... requirements (eg, CLIA '88, JCAHO, CAP, OSHA). Personnel report to department supervisor . May be responsible for the collection, receipt, and processing of… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor , Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... standards and federal/state regulations and general principles relating to utilization review. + Computer skills, including Microsoft Office programs. +… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... schedules to efficiently handle incoming referrals and phone call volume. You will develop workflows, desktop procedures, forms, training materials, and protocols for achieving team objectives and key performance indicators. You will hire and train… more
- Centene Corporation (Atlanta, GA)
- …adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues + ... knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management team… more
- SSM Health (MO)
- … of daily operations within assigned region(s) or ministries related to the Utilization Management (UM) Review area under the direction of managers. Interacts ... Responsibilities and Requirements:** PRIMARY RESPONSIBILITIES + Responsible for daily Utilization Management (UM) operations, which includes referrals, medical… more
- Centene Corporation (Madison, WI)
- …to ensure appropriate care for members and supervises day-to-day activities of BH utilization management team. + Monitors behavioral health (BH) utilization ... adherence to performance, quality, and efficiency standards + Works with BH utilization management team to resolve complex BH care member issues related to BH… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. In this role as a Utilization Review Supervisor within our utilization department you would be responsible for ... services within NPH. This role entails overseeing a team of utilization review nurses, ensuring compliance with clinical regulatory standards, and enhancing… more
- Hartford HealthCare (Wethersfield, CT)
- …Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management ... department. *_Position Responsibilities:_* 1. Monitors and manages assigned utilization management reports, including the Payer End of Day report, Utilization… more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role...requirements are met + Additional duties as requested by supervisor + Maintains knowledge of CMS, State and NCQA… more
