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Supervisor Utilization Management Review Jobs

Supervisor, Concurrent Review Jobs
By MJHS At , New York, Ny $101,503 - $126,879 a year
Sign-on Bonuses OR Student Loan Assistance for clinical staff
FREE Online RN to BSN and MSN degree programs!
Tuition Reimbursement for all full and part-time staff
Dependent Tuition Reimbursement for clinical staff!
Affordable medical, dental and vision coverage for employee and family members
Two retirement plans! 403(b) AND Employer Paid Pension
Utilization Review Nurse Supervisor Ii
By Los Angeles County Department of Human Resources At , , Ca $107,591 - $161,050 a year
Plans, develops, and implements procedures to fulfill the Professional Standards Review organization requirements for an effective and timely utilization review system.
FALSIFICATION of any information may result in DISQUALIFICATION or RECISSION OF APPOINTMENT.
Directs the utilization review function through subordinate supervisors, conferring with supervisors on personnel, and technical and administrative problems.
Evaluates the performance of subordinate supervisors and reviews their evaluations of Utilization Review Nurses; counsels subordinates on their performance.
For this examination, supervision MUST include all the following: planning, assigning, reviewing work of staff and evaluating employee performance.
Bachelor of Science degree in Nursing (BSN) or higher from an accredited institution.
Supervisor Ltss Utilization Management Non-Clinical
By AmeriHealth Caritas At , Remote
Performs and remains knowledgeable in all workflow and timeliness requirements for all areas in Utilization Management
Strong knowledge base of health care resources, ideally with managed care experience.
Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
Assist the LTSS UM Manager in providing oversight for operational reporting compliance
Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.
Reviews quality audits and shares audit results in a timely manner with associates, providing necessary education and counseling to improve performance.
Clinical Care Reviewer, Utilization Management Review, Registered Nurse, Remote
By AmeriHealth Caritas At , Remote
Experience performing utilization management reviews (prior authorization and concurrent reviews) in a managed care organization.
3 or more years of experience in a related clinical setting as a Registered Nurse.
Strong written and verbal communication skills.
Associate’s Degree required; Bachelor’s Degree preferred.
Current unrestricted North Carolina or compact Registered Nurse license required.
Proficiency utilizing MS Office and electronic medical record and documentation programs.
Supervisor, Utilization Management (Medicare) - 015252
By Excellus At , Rochester, 14604, Ny
Applies project management skills by developing and implementing new initiatives.
Identifies strategies to improve health care resource management and communicates to internal and external customers.
Maintains knowledge of all relevant legislative and regulatory mandates and ensures that all activities are in compliance with these requirements.
Performs other duties and functions as assigned by management.
Experience in interpreting health plan benefit plans
Basic familiarity with Managed Care legislation, NCQA, and Federal and State regulatory requirements
Pool Utilization Review Registered Nurse, Case Management
By Boca Raton Regional Hospital At , Boca Raton, Fl $45 an hour

Baptist Health has a commitment to strengthening the compassionate care we provide. With the addition of Boca Raton Regional Hospital, Baptist Health is able to provide the Palm Beach community ...

Utilization Management Review Nurse (11:00A-7:30P Shift)
By DANE STREET LLC At , Remote
Utilization Management experience is strongly preferred.
Experience working in a remote environment is preferred.
Serves as an additional level of QA and clinical knowledge/review for cases with quality Issues.
Experience in a medical office or health care background.
Excellent written and verbal communication skills are required.
Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).
Supervisor - Utilization Management - Rn
By Scripps Health At , San Diego, 92127, Ca $61.58 - $92.39 an hour
One year of Utilization Management RN experience.
Minimum of 2 years experience in case management/utilization review, discharge planning, and Millman/InterQual criteria usage.
BSN, knowledge of health plan benefit coverage and regulations.
Knowledge of managed care operations.
Proficiency in MS Office software, and ability to quickly learn a variety of case management systems.
One year of applicable leadership experience.
Utilization Review Rn (Prn Case Management) Montgomery Medical Center
By MEDSTAR HEALTH At , Olney, 20832, Md $35 - $50 an hour

Pay: $35.00 - $50.00 per hour

Registered Nurse (Quality Management/Risk Management And Utilization Review)
By US Veterans Health Administration At , Martinsburg, 25405, Wv $65,962 - $126,324 a year
If you are relying on your education to meet qualification requirements:
Participation in the seasonal influenza vaccination program is a requirement for all Department of Veterans Affairs Health Care Personnel (HCP).
Nurse I Level I - An Associate Degree (ADN) or Diploma in Nursing, with no additional nursing practice/experience required.
Major Duties and Responsibilities include, but are not limited to:
You will be evaluated for this job based on how well you meet the qualifications above.
IN DESCRIBING YOUR EXPERIENCE, PLEASE BE CLEAR AND SPECIFIC. WE MAY NOT MAKE ASSUMPTIONS REGARDING YOUR EXPERIENCE.
Case Management Utilization Review Rn
By Steward Health Care At , Dallas, 75201, Tx
Collaborates with the multidisciplinary team to assist patient with benefits management.
Leadership skills required for role include effective mentoring, coaching, counseling, time management, problem solving, and strategic planning.
Experience (Type & Length): Three to five years of acute medical/surgical experience plus three to five years of Case Management experience.
Certification/Licensure: RN license required; Certification in Case Management (CCM) strongly preferred.
The Care Manager works collaboratively with all healthcare disciplines to assure appropriate and timely services.
Adaptability to change and good organizational skills required. Ability to read and communicate effectively in English.
Weekend Utilization Management Front End Review Registered Nurse
By Humana At , Tampa, 33610, Fl
Previous experience in Utilization Management
3 or more years experience preferably in an acute care- inpatient hospital setting.
Must be passionate about contributing to an organization focused on continuously improving consumer experiences
Strong general computer skills in an autonomous work setting.
Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job.
Utilize MCG criteria to perform acute concurrent front end reviews on Humana members to determine medical necessity.
Utilization Management Clinical Supervisor Rn
By Texas Children's Hospital At , Houston, 77001, Tx
5 years of utilization management experience
Identify training opportunities and develop training curriculum in collaboration with manager and education department
3 years of licensed nursing experience
Strongly Preferred: BSN and 8+ years of nursing experience
Maintain current knowledge and contacts related to initial and concurrent review functions
Identify and develop specific programs and create educational training for staff in areas defined by trended data