Utilization management jobs in Nutley, NJCreate job alerts

Center 1 (19052), United States of America, McLean, VirginiaSr. Distinguished Engineer - Platform OperationsAt Capital One, we believe that AI and machine learning represent the biggest opportunity in financial services today, and is a chance to revolutionize the industry with more real-time pers...

201 Third Street (61049), United States of America, San Francisco, CaliforniaAI Engineer - Sr. Manager Level (IC)Overview: At Capital One, we are creating trustworthy and reliable AI systems, changing banking for good. For years, Capital One has been leading the industry in using machine learning...

130 5th Ave (22130), United States of America, New York, New YorkAI Engineer - Principal Associate LevelOverview: At Capital One, we are creating trustworthy and reliable AI systems, changing banking for good. For years, Capital One has been leading the industry in using machine learning to creat...

Center 3 (19075), United States of America, McLean, VirginiaLead AI EngineerOverview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create real-time, personalized cust...

Center 3 (19075), United States of America, McLean, VirginiaSenior Manager, AI EngineerOverview: At Capital One, we are creating responsible and reliable AI systems, changing banking for good. For years, Capital One has been an industry leader in using machine learning to create real-time, person...

Bachelor's Degree or equivalent work experience in management for a health plan or utilization/case management Required. Minimum of four years experience in home care, care management or related field, including three years of progressive experience in case or utilization Management Required. Mon...

Utilization Management Specialist MSH Case Management FT Days. Position responsibilities will include utilization management support functions for patient admissions and continuing stay. This position also facilitates and tracks concurrent adverse determinations and collaborates with Appeals Mana...

Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based practice standards and regulatory/payor requirements and follows th...

Supervise the management of the Denial Management System of the Utilization Management Department. Duties & ResponsibilitiesPurpose of Position:Under general supervision of the Director of Utilization Management, assists with the planning, organizing, directing, coordinating, and evaluating of nu...

Performs all Utilization Management activities in compliance with all regulatory agency requirements. MetroPlusHealth Utilization Management policies, procedures, and protocols. Assists all departments with the resolution of members' problems related to utilization management issues.

MetroPlusHealth Utilization Management policies, procedures, and protocols. Informs member and provider of Utilization Management determinations and treatment alternatives. Assists all departments with the resolution of members' problems related to utilization management issues.

The Market Medical Director for Utilization Management will support WellMed Medical Management, Inc. Conducts post service reviews issued for medical necessity and benefits determination coding. Develops strategies for improving all aspects of market performance including RAPS, membership, and me...

For Utilization Management Only:. Ensures all records/logs related to decision requests, Notices of Action, and other communications required by state or federal regulations are saved in the Utilization Management System. Coordinates with management, subject matter experts, physicians, member rep...

Informs member and provider of Utilization Management determinations and treatment alternatives. Performs all Utilization Management activities in compliance with all regulatory agency requirements. MetroPlusHealth Utilization Management policies, procedures, and protocols.

The Case Management Care Coordinator, Utilization Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilizatio...

The Care Manager will assist the provider in directing care to the most appropriate setting, evaluating alternative care plans, and assessing outcomes through outreach to the members. The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for man...

Precertification: Utilization Management Nurse Consultant. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function. Prior Authorization or Utilization Management experience.

Active New York State Licensed Practical Nurse (LPN) or Registered Nurse (RN) license. Utilization Management Nurse (MLTC Focus). Remote, New York (Active NY nursing license required).

The Care Manager under the direction of the Vice President of Clinical Services, is primarily responsible for managing both simple and complex medical cases to achieve high-quality patient care outcomes and minimize unnecessary medical expenses, through the coordination of services, both outpatie...

Precertification: Utilization Management Nurse Consultant - SCPU.

Under the direction of the Business Office Manager, is responsible for covering any aspect of the ... Utilization of various collection strategies and methodologies to contact consumers in order to ...

This partnership will provide a comprehensive clinical resource management program that includes utilization management, progression of care management, social work services, and complex discharge ...

Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization ...

Responsible for the quality and resource management of all patients that are admitted to the facility from the point of their admission and across the continuum of the health care management. Works ...