accuracy, and driving efficiency to support timely and compliant claims outcomes. Leads utilization management team... within scope of responsibility Partner closely with claims and clinical and non-clinical Utilization Management (UM) team members...
: $195,000 - $215,000 per year WHAT YOU WILL DO: Lead daily operations of the Utilization Management department, including prior authorization... and authorization processes. Participate in internal and external committees, including the Utilization Management Committee...
like you, apply to our Medical Director-Inpatient Utilization Management opportunity today! Iowa or South Dakota-based candidates preferred..., etc.). Additional Information What you will do as a Medical Director for Inpatient Utilization Management (UM): a. Demonstrate...
like you, apply to our Medical Director-Inpatient Utilization Management opportunity today! Iowa or South Dakota-based candidates preferred..., etc.). Additional Information What you will do as a Medical Director for Inpatient Utilization Management (UM): a. Demonstrate...
like you, apply to our Medical Director-Inpatient Utilization Management opportunity today! Iowa or South Dakota-based candidates preferred..., etc.). Additional Information What you will do as a Medical Director for Inpatient Utilization Management (UM): a. Demonstrate...
-service operations under the direction of the Director of Utilization Management. This role provides leadership... but saving them. Together. The Manager, Utilization Management (UM) Coordination, oversees non-clinical inpatient and pre...
-clinical tasks related to processing Utilization Management prior authorization sand appeals. JOB RESPONSIBILITIES Monitor... and claim history in proprietary claims platform Verify all necessary documentation has been submitted with authorization...
Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization...Job Category: Admin Support/Clerical Job Description: Summary The LPN Utilization Management (UM) Reviewer...
information required by clinical staff to render decisions, assists the Manager and Director of the Utilization Management... Technician II supports the Utilization Management (UM) Specialist by handling all administrative and technical functions of the...
. This position accurately prepares and interprets cases for UM (utilization management) reviews and determination. In addition, the... functions such as member services, claims, and the referral/authorization process. This position provides leadership...
accurately prepares and interprets cases for UM (utilization management) reviews and determination. In addition, the Technician... functions such as member services, claims, and the referral/authorization process. This position provides leadership...
and operational leadership to the Prior Authorizations (PA) team within the Utilization Management (UM) function. You will manage... efficiency, accuracy, or quality gaps. Manage clinically related authorization and claims issues, escalating appropriately...
and operation of Care Management and Utilization Review along with having the ability to make decisions based on sound judgment when.... Assists the Utilization Management Committee in the assessment and solution of identified utilization review problems...
and operation of Care Management and Utilization Review along with having the ability to make decisions based on sound judgment when.... Assists the Utilization Management Committee in the assessment and solution of identified utilization review problems...
and determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls... Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh...
management and/or utilization review experience Associate degree required; bachelor's Degree preferred. Strong problem-solving... Utilization Manager is responsible for the day-to-day functions of collaborative communication with external case managers...
management and/or utilization review experience Associate degree required; bachelor's Degree preferred. Strong problem-solving... Utilization Manager is responsible for the day-to-day functions of collaborative communication with external case managers...
RN Utilization Management Nurse – Frontline Opportunity Greater Orlando, Florida The RN Utilization Management Nurse..., and appropriate level of care. The Utilization Management RN leverages the algorithmic logic of the platform, utilizing key clinical...
more about this great opportunity! The Director of Care Navigation & Medical Cost Management leads a multidisciplinary team of Navigators... on diabetes and ESRD. Collaborate with utilization management (UM) vendors and internal teams to optimize site-of-care decisions...
Job Description: Description Director Pre Appeals Management-HSO Appeals Management -Corporate 42nd Street-Full...-Time-Days -Remote The Director, Pre Appeals Management is a strategic enterprise leader who provides strategic leadership...