Utilization management jobs in Union City, 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, CaliforniaDistinguished 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 re...

Experience in utilization review, concurrent review and/or risk management. Ensures standardized execution of workflow processes, including conducting performance audits, quality reviews, and compliance adherence. Review and manages operational reports to monitor staff productivity and program ef...

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. Generates management reports via the care/utilization management systems and demonstrates competency as a super user of thes...

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...

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...

Supervise the management of the Denial Management System of the Utilization Management Department. Determine, outline, and review daily assignments for all staff of the Utilization Management Department. Supervision of staff of the Utilization Management Department.

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.

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. WellMed Medical Management's utilization management program. All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.

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

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. For Utilization Management Only:. Coordinates with management, subject matter experts, physicians, member rep...

Calling all healthcare rockstars! Are you a RN (Registered Nurse) with experience in Case Management (Utilization Review) If so, you might be the right fit for this travel healthcare position in Bronx, NY.

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 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...

CVS Health also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. We want ev...

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...

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...

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...

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.

The Director of Utilization and Case Management will spearhead the strategic direction, management, continuous improvement, and overall maintenance of the Utilization and Case Management Services Unit. Lead the Utilization and Case Management Department at University Hospital, a prestigious healt...

Precertification: Utilization Management Nurse Consultant - SCPU.

The NP is responsible for managing protocols for study subjects enrolled in therapeutic and non ... Familiarity with database utilization, regulatory compliance and human subject's protection issues

Train finance staff in proper utilization of the automated financial management system. * Provide ad hoc support to the financial management system team. Applied Knowledge & Skills: * Strong critical ...