beBeeUtilizationManagement Jobs in United States

This role is ideal for candidates with a background in patient health support who are looking to make a meaningful impact behind the scenes by evaluating certification requests and reviewing group specific requirements. · ...

Job Title: · Nurse Consultant for Utilization Management and Care Coordination · ...

Job Overview · This role is crucial in supporting the management of healthcare services by providing administrative support and customer service. The ideal candidate will have strong analytical skills, excellent communication abilities, and a keen sense of organization. · The suc ...

About This Role · We are seeking a skilled and compassionate registered nurse with expertise in utilization management to join our team at Cedars-Sinai Medical Center. · This is an excellent opportunity for a dedicated professional who shares our commitment to delivering exceptio ...

Job Description · We are looking for an experienced nurse manager who can lead our team of professionals in delivering exceptional patient outcomes. · The right candidate will possess excellent communication skills, be able to manage multiple priorities simultaneously, and mainta ...

We are seeking a skilled Clinical Program Manager to lead our efforts in utilization management. · Duties & Responsibilities · Analyze data to identify high-value opportunities and prioritize them for implementation. · In addition, you will oversee medical management operations, ...

About the Role: · The successful candidate will be responsible for facilitating patient placement in appropriate levels of care based on medical necessity. · ...

About This Role · We are seeking a skilled Utilization Management Nurse to join our team. As a key member of our department, you will play a vital role in ensuring the delivery of high-quality care to our members. · ...

About This Role · We are seeking an experienced clinician who can play a key role in our team's efforts to improve patient outcomes while controlling costs. · Your primary responsibility will be assessing member needs and developing plans for delivering care within established gu ...

About the Position · The Pre-Certification Review Nurse – Pharmacy plays a crucial role in reviewing and processing coverage determinations and utilization management reviews for specialty medications. This involves site of care assessments to ensure that patients receive the nec ...

Key Responsibilities:Clinical interviews via telephone or telemedicine platform to assess patient health records, risks, and medical documentation needs. · ...

Responsibilities include but are not limited to: Facilitating inbound and outbound calls to customers (members and providers) with the goal of delivering exceptional customer-centered service · , The incumbent must possess a thorough understanding of managed care principles as we ...

Job Description · Develop comprehensive resident-centered discharge plans that incorporate individualized goals into the plan of care · We are seeking an experienced Social Worker who can take charge of our social services team by assessing residents' physical, emotional, social ...

Ensure Optimal Care Outcomes · Clinically Coordinate Member Services · ...

Job Title: Behavioral Health Utilization Mgmt Clinician, Senior · Your Role · ...

Job Overview · This position entails monitoring inpatient and outpatient accounts to ensure accurate submissions and obtain proper authorizations for reimbursement. The key performance indicator is reducing bill holds through effective collaboration with the clinical team, includ ...

Clinical Oversight Specialist - Travel Assignment · As a Clinical Oversight Specialist, you will utilize your nursing expertise in an exciting travel assignment where you will contribute to the improvement of patient outcomes by reviewing cases interpreting policies collaborating ...

Healthcare Career Opportunity · The Pre-Authorization Nurse Specialist plays a vital role in the healthcare system, reviewing prior authorization requests to ensure that patients receive appropriate care and services. This position requires strong clinical judgment and decision-m ...

As a Utilization Management Nurse Consultant, you will be part of a 24/7 operation that requires collaboration and effective communication. The role involves assessing, planning, implementing, coordinating, monitoring and evaluating options to facilitate appropriate healthcare se ...

Job Overview · The role of an inpatient utilization management RN entails facilitating efficient care pathways, coordinating comprehensive discharge planning, and ensuring accurate documentation. · This position requires strong analytical skills to identify and document the appro ...