Utilization management (UM) or utilization review is the use of managed care techniques such as prior authorization that allow payers, particularly health insurance companies to manage the cost of health care benefits by assessing its appropriateness before it is provided using evidence-based criteria or guidelines. Critics have argued if cost cutting by insurers is the focus of their use of UM criteria, it could lead to healthcare rationing by overzealous denial of care as well as retrospective denial of payment, delays in care, or unexpected financial risks to patients.
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Description. Under the direction and supervision of the Utilization Management Manager, the Utilization Management Specialist is responsible for overseeing the research, resolution and workflow development of out-of-network (OON) referral requests. This role reviews OON referral requests from members and providers, acting as a key liaison to facilitate timely, accurate, and efficient processing. In addition, the UM Specialist will. Ensure complia...
Job: Case Manager Director. Classification: Salaried/Exempt. Job Category: 1.2 First/mid-level officials and managers. Position Summary. The RN Case Manager Director oversees the Social Services unit to ensure the necessity of admission of patients by monitoring the necessity of admission and continued stay of patients. The Case Manager Director oversees the utilization management of each patient, conducts reviews, and ensures proper status of pa...
Our client, a nationally recognized and award-winning company in the health insurance vertical, has a contract opening for a Utilization Management Specialist. They have over 4 million customers and 5,000 employees dedicated to providing innovative solutions that simplify the healthcare system, improve efficiency and outcomes while reducing costs. Location. While the position is Remote, work from home, you must reside in North Carolina or one of ...
Location. This position will be remote. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. The. Utilization Management Representative I. is responsible for coordinating cases for precertification and prior authorization review. How You Will Make An Impact. Manage incoming calls or incoming post services claims work. Determine contract and benefit eligibility. provides authorization for inpatient admi...
Location. This position will be remote. The ideal candidate will live within 50 miles of one of our Elevance Health PulsePoint locations. The. Utilization Management Representative I. is responsible for coordinating cases for precertification and prior authorization review. How You Will Make An Impact. Manage incoming calls or incoming post services claims work. Determine contract and benefit eligibility. provides authorization for inpatient admi...
Overview. Join the transformative Southcoast Behavioral Health team and be part of a difference-making journey every day. Southcoast Behavioral Health, located in Dartmouth, Massachusetts, is a premier mental health treatment center with 192 beds. We serve pediatric, adolescent, adult, and geriatric patients, as well as adults with co-occurring mental health and substance use disorders. PURPOSE STATEMENT. Proactively monitor utilization of servic...
Shape the future of healthcare in Palm Coast by becoming our next Medical Director. We believe in bringing “better” to our local Palm Coast, Florida community—better care, better collaboration, and a deep commitment to the people we serve. We’d love to talk if you’re looking for a role that supports your professional growth while contributing to a vibrant community. People First in Palm Coast. Local Team Collaboration. Join our team of 24 physici...
POSITION: Medical Director. SCHEDULE. Full-Time. FACILITY: Lawrence. LOCATION: Sumner, IL. A Job Should be. MORE. than just a paycheck. Wexford Health Sources, Inc. is one of the nation's largest correctional health care providers. Over the past 30 years, our team of dedicated clinical professionals has helped literally millions of justice-involved patients receive life-changing medical and mental health services. The majority of our patients com...
POSITION: Medical Director. SCHEDULE: Part-Time. FACILITY: Salem C. LOCATION: Martinsburg, WV area. A Job Should be. MORE than just a paycheck. Wexford Health Sources, Inc. is one of the nation's largest correctional health care providers. Over the past 30 years, our team of dedicated clinical professionals has helped literally millions of justice-involved patients receive life-changing medical and mental health services. The majority of our pati...
Job Description. POSITION: Medical Director. SCHEDULE: Part-Time. FACILITY: Martinsburg Correctional others. LOCATION: Martinsburg, WV area. A Job Should be. MORE than just a paycheck. Wexford Health Sources, Inc. is one of the nation's largest correctional health care providers. Over the past 30 years, our team of dedicated clinical professionals has helped literally millions of justice-involved patients receive life-changing medical and mental ...
Director of Case Management. Job ID. 301924. Location. US-NJ-West Orange. Experience (Years). 1. Category. Clinical - Case Manager. Street Address. 1199 Pleasant Valley Way. Company. Kessler Institute for Rehabilitation - West (West Orange). Position Type. Full Time. Overview. Kessler Institute for Rehabilitation |. Select Medical. West Orange, NJ. Director of Case Management. Inpatient Rehab. Shift Hours. . Full Time, 8:30 AM to 4:30 PM. Kessler...
