Utilization Management Representative

DescriptionOn a day to day basis, a person in this role will review dental prior authorizations and dental referrals. Make sure the members history does not have any conflicting info, make sure the proper attachments (xray of tooth) are on claims, work thru the system and finalize cases as needed.Additional Skills & Qualifications-2+ years of dental...

Job DescriptionJob DescriptionDescriptionOn a day to day basis, a person in this role will review dental prior authorizations and dental referrals. Make sure the members history does not have any conflicting info, make sure the proper attachments (xray of tooth) are on claims, work thru the system and finalize cases as needed.Additional Skills &...

Join our team of more than 34,000 team members, supporting our members and communities in our Club Support Center, 235+ clubs and eight distribution centers. BJ's Wholesale Club offers a collaborative and inclusive environment where all team members can learn, grow and be their authentic selves. Together, we're committed to providing outstanding service and...

A well-established hospital in the California Central Valley is actively searching for a Utilization Management RN to join their team. This 150+ bed short-term acute care hospital has proudly provided care to San Joaquin Valley residents for over half a century. Medical services include 24-hour Emergency Services, OB Services, Pediatrics, Physical...

Join our team of more than 34,000 team members, supporting our members and communities in our Club Support Center, 235+ clubs and eight distribution centers. BJs Wholesale Club offers a collaborative and inclusive environment where all team members can learn, grow and be their authentic selves. Together, were committed to providing outstanding service and...

Join our team of more than 34,000 team members, supporting our members and communities in our Club Support Center, 235+ clubs and eight distribution centers. BJ's Wholesale Club offers a collaborative and inclusive environment where all team members can learn, grow and be their authentic selves. Together, we're committed to providing outstanding service and...

Job DescriptionJoin our team of more than 34,000 team members, supporting our members and communities in our Club Support Center, 235+ clubs and eight distribution centers. BJ’s Wholesale Club offers a collaborative and inclusive environment where all team members can learn, grow and be their authentic selves. Together, we’re committed to providing...

An exceptional full-service acute care hospital in Southern California is actively interviewing for a Nursing Manager to oversee a complex Utilization Management (UM) and Case Management program. Join this reputable hospital as it leads patient care into the next generation. This state-of-the-art, 350+ bed hospital seeks an experienced full-time Nurse...

Bring your heart to CVS Health. Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we...

WE ARE SEEKING TO FILL SEVERAL CUSTOMER REPRESENTATIVE POSITIONS! LOOKING FOR INDIVIDUALS THAT HAVE EXPERIENCE IN CUSTOMER SERVICE, SALES, MARKETING! We have expanded our marketing and current growth within our major clientele which has created an opportunity for a role to oversee various accounts. Our company's team is composed of individuals who are...

Pioneer Management Consulting - Director, Energy and Utilities Location: Denver, Colorado As the Director of Energy & Utilities, you will be responsible for planning, directing, and coordinating the Energy Portfolio within the business. Responsibilities include: Provide comprehensive oversight and leadership for cross-practice delivery activities, including...

Purpose : The Bulk Utility Representative will be responsible for providing "sales" and "services" of approved waste streams at automotive and industrial businesses. This position will work frequently with hoses to load/offload Oil Tanker Trucks and Vacuum Trucks from a variety of containers, waste storage units, trenches, and sub-terrain holding chambers....

Your Role The Medical Management team ensures that Blue Shield is on the cutting edge of medical, medication, and payment policy to accelerate the emergence of a value-based health care system in California. The Medical Director, Utilization Management will report to the Sr. Medical Director, Utilization Management. In this role, you will deliver and...

Summary SUMMARY: Manages the utilization of the AHS designated patient population including, but not limited to, care coordination and medical determination for Outside Medical Services functions and managing the referral network. DUTIES & ESSENTIAL JOB FUNCTIONS: NOTE: The following are the duties performed by employees in this classification, however,...

Utilities Unit ManagerReports To: Maintenance, Reliability, & Utilities ManagerDirect Reports: 1 direct report, 24 indirect reports Responsibilities: Leadership & Team Management: Lead a team of professionals and associates to achieve key performance indicators in plant utilities. Monitor, coach, and develop team members, ensuring alignment with...

Utilization Management Nurse, Senior at Blue Shield of California summary: The Senior Utilization Management Nurse is responsible for reviewing inpatient stays and applying guidelines for medical necessity in compliance with state and federal regulations. This role involves conducting clinical reviews, discharge planning, and presenting cases to the...

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...

Job Description: Tittle: RN Utilization Management Location: Boise, ID Duration: 13 weeks Guranteed hours: 40 hrs Pay Package: Total weekly gross $4171 W2: $60/hr Per Diem/Stipend: $1771/weekly non taxable Shifts: Mon-Fri 8am-5pm Minimum Years of Experience: 5+yrs Sub Specialty: Utilization Management, Case Management (Utilization Review) General...

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...

Your Role The Utilization Management team reviews the inpatient stays for our members and correctly applies the guidelines for nationally recognized levels of care. The Utilization Management Nurse will report to the Utilization Management Nurse Manager. In this role you will be assigned a list of inpatient facilities and then review clinical information...