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Supervisor Utilization Management Review Jobs

Behavioral Health, Utilization Management Review, Lcmhc/Lcsw/ Rn
By AmeriHealth Caritas At , Greensboro
Two or more years of behavioral health experience.
Strong problem solving skills and decision making skills.
This position requires residency in the state of North Carolina.
Current active professional licensure required in North Carolina: LCMHC, LCSW, RN
Proficiency in Microsoft Office, including Word, Excel and Outlook is required.
Ability to communicate in a positive/professional manner both orally and written.
Dme Utilization Management Clinical Supervisor
By Kaiser Permanente At , Walnut Creek $71.25 - $92.17 an hour
Demonstrated experience in utilization management, discharge planning, or transfer coordination.
Previous case management experience preferred.
Must be able to work in a Labor/Management partnership environment.
Bachelors degree in nursing or health related field OR four (4) years of experience in a directly related field.
High School Diploma or General Education Development (GED) required.
Knowledge of Nurse Practice Act, TJC, and other federal/state/local regulations.
Utilization Review Nurse/ Care Management – Full Time
By Montefiore Nyack Hospital At , Nyack From $110,000 a year

Description Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to ...

Supervisor Long Term Services & Support Utilization Management Review, Rn - Remote
By AmeriHealth Caritas At , Philadelphia, 19103
Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
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.
Responsible for writing and finalizing annual reviews for direct reports with Manager input.
Accurately answers questions regarding CHC benefits for members and providers.
Maintains awareness and complies with Plan CHC authorization timeliness standards based on DHS/NCQA requirements.
Utilization Review Licensed Vocational Nurse (Lvn) – Utilization Management- Remote
By Kelsey-Seybold Clinic At , Pearland, Tx $54,186 - $66,936 a year
Job Title: Utilization Review Licensed Vocational Nurse (LVN) – Utilization Management
Required: Licensed Vocational Nurse, CEU requirement.
Preferred: Computer and Coding experience.
Required: Good organization and communication skills
Required: HMO, PPO and POS insurance knowledge
Employee Reward and Recognition Program
Technical Review Supervisor - Remote
By PosiGen At Harahan, LA, United States
Supervise, train, and develop the Channel Technical Review Service team and offer help with solving issues
Conduct remote site inspections confirming PV installation was installed per our standards and meets Building and Electric code
Work with team on daily, weekly, and monthly goals of completing remote site inspections
Keep up with code changes and requirements for all partner markets
Research code requirements, procedures or processes for new markets
Manage the accuracy and timely approval of partner quality assurance submissions
Supervisor, Hcs Operations Support - Ideal Candidate Will Have Utilization Management (Um) Experience
By Molina Healthcare At California, United States
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
2+ years’ experience in an administrative support role in healthcare, Medical Assistant
Strong analytic and problem-solving abilities
1+ years of supervisory experience
3+ years’ experience in an administrative support role in healthcare, Medical Assistant preferred.
Works closely with members, providers, regulators, and Molina departments to resolve issues and concerns.
Registered Nurse Coordinator - Utilization Review Clinical Care Management
By St. Joseph's Health At , Syracuse, 13203, Ny
Maintain the prescribed workload including work queue management, process oversight and committee responsibilities.
Education, Training, Experience, Certification and Licensure:
Participating in Revenue Cycle functions including work queue and account management, monitoring metrics, and attendance at meetings.
Participate in interdisciplinary meetings regarding UR and denials management, including retroactive chart reviews, data collection, and process development.
Maintain BLS/CPR certification. Maintain other certifications appropriate to field.
Career advancement to senior leadership roles such as Manager, Director or Administrative roles.
Rn Utilization Review/Case Management - Behavioral Health
By PeaceHealth At , Springfield, 97477, Or
Maintains issue tracker related to third party denials and interfaces with management as needed to initiate investigation of denials.
Oversees and supports staff with wound care and patient education.
Attends unit leadership meetings. Collaborates regarding unit issues and quality assurance. Provides staff education as appropriate.
Working knowledge of psychiatric diagnostics required
Third party reimbursement knowledge desirable
Willingness to work toward CPUR certification preferred
Rn Utilization Review Specialist - Case Management
By Keck Medical Center of USC At , Los Angeles, 90015, Ca $47.31 - $88.00 an hour
Req 3 years Case management experience in an acute care hospital setting
Assists with denial management to identify opportunities to improve department processes
Demonstrates collaborative working relationships with case managers and payers to ensure authorizations are obtained and current.
Maintains awareness of payer/reimbursement practices and requirements.
Req 3 years Clinical experience.
Req 1 year Experience utilizing InterQual Criteria in CERME format.
Utilization Review Nurse Full Time – Care Management
By Montefiore Nyack Hospital At , Nyack, Ny

Description Comprehensively plans with the health care team to ensure patient needs are met and care delivery is coordinated across the continuum. Identifies and works to eliminate/minimize ...

Supervisor - Utilization Review: Corp - Utilization Review
By Memorial Healthcare System At , Hollywood, Fl
Monitors department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control.
MANAGING PEOPLE: Uses HR/Performance Management processes and systems to align individual performance to achieve organizational results.
Assists UR Director in planning and monitoring staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives.
ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
Care Management Coordinator – Utilization Review (40 Hours/Week, Days)
By EvergreenHealth At , Kirkland, 98034, Wa $20.57 - $32.92 an hour
One (1) year of progressively responsible experience in office or general administrative work
Current Healthcare Provider BLS certification by date of hire
Possesses excellent organizational skills and attention to detail
One (1) year experience in a medical setting
Knowledge of community resources and referral process
Pay in lieu of benefits premium program
Clinical Review- Utilization Management
By BlueCross BlueShield of Tennessee At , Chattanooga, 37402, Tn
3 years - Clinical experience required
Working knowledge of URAC, NCQA and CMS accreditations
Excellent oral and written communication skills
Strong interpersonal and organizational skills
Ability to manage multiple projects and priorities
Superior interpersonal, client relations and problem-solving skills
Supervisor - Utilization Review: Corp - Utilization Review
By Memorial Healthcare System At Hollywood, FL, United States
Monitors department operations, including information technologies, service level determination and complaint management, to achieve performance and quality control.
MANAGING PEOPLE: Uses HR/Performance Management processes and systems to align individual performance to achieve organizational results.
Assists UR Director in planning and monitoring staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives.
ANALYSIS AND DECISION MAKING: Uses decision making processes and tools to analyze situations and make effective decisions.
EFFECTIVE COMMUNICATION: Communicates effectively with various audiences using the most appropriate method for the situation.
Lifting or Carrying 0 - 25 lbs Non-Patient 60.00%
Supervisor, Utilization Management (Prior Authorizations)
By CalOptima At , Orange, 92868, Ca
3 years of clinical nursing experience or utilization management experience required, preferably in a managed care environment.
2 years of progressive leadership experience, including direct supervision of staff in managed care and/or utilization management required.
Provides coverage and expertise for other teams within the Utilization Management department.
Supervisor, Utilization Management (Prior Authorizations)
Assists the team in carrying out department responsibilities and collaborates with others to support short- and long-term goals/priorities for the department.
Assists the manager as needed to ensure departmental and agency goals are met.
Utilization Review (Lvn/Rn), Medical Management - Ft/Days
By MemorialCare Medical Foundation At , Fountain Valley, 92708, Ca $42.68 an hour
Minimum 2 years of utilization / care management experience applying evidence-based criteria.
Experience performing medical management (UM) in electronic referral application preferred.
Utilization Review (LVN/RN), Medical Management - FT/Days
Assures review turnaround times adhere to timeliness standards set by contracting and regulatory requirements and established productivity and quality guidelines.
Implement and maintain systems and processes that meet various regulatory requirements.
Maintain and demonstrate a complete understanding of own scope of practice of licensure and education level.
Hr Medical Review Supervisor (Onsite In Columbia, Sc)
By BlueCross BlueShield of South Carolina At , Columbia, Sc
Manages day-to-day activities for assigned staff. Identifies training needs and verifies accuracy and timeliness of workflow functions.
Five years clinical OR five years utilization review/medical review experience (three of the five must be clinical).
Experience with ADA, FMLA, leave of absence, employee health and/or occupational health.
Our comprehensive benefits package includes:
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
This position is onsite in our Columbia, SC office on Clemson Road.
Supervisor, Utilization Management Review, Registered Nurse, Remote
By AmeriHealth Caritas At , Raleigh, Nc
Assists with the daily operations of licensed and non-licensed professionals on the Utilization Management team.
Provides coaching and counseling to improve productivity of staff members within Utilization Management.
Minimum 3 years of experience in managed care utilization review (prior authorization/concurrent review) in an insurance company/managed care organization.
Experience leading a remote team of clinical professionals.
Monitors staff work assignments and makes appropriate adjustments based on staffing levels, staff experience, and number/request types of authorizations/appeals received.
Assesses candidates and ensures that optimal qualifications are met as a member of the department’s interview team.
Supervisor, Utilization Management And Clinical Documentation Improvement
By Memorial Health System At , Jacksonville, Il
Knowledge and skill in the use of computer software applications for drafting documents, data management, and tracking.
Minimum one (1) year experience with supervisory/ management experience
HMO, managed care, PPO, Utilization Management experience
Manages the time and attendance of supervised colleagues.
Promotes UM and CDI as a key aspect of patient care, providing education to staff and medical team.
Minimum three (3) year experience with Milliman and/ or InterQual