Utilization Manager Jobs in Orange
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Search Results - Utilization Manager Jobs in Orange
Equiliem-Orange
for assessing the medical appropriateness, quality, and cost-effectiveness of proposed hospital/medical/surgical services in accordance with established criteria.
Position Information
Department: Utilization Management
Work Arrangement: Full Office
Duties...
resume-library.com -
Orange
will respond to verbal and written grievances and appeals from members and providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions and pharmacy and vision decisions.
The incumbent...
governmentjobs.com -
Impresiv Health-Orange
behavioral health providers. The incumbent is responsible for utilization management, quality reviews and monitoring activities of BHT services. The incumbent will directly interact with providers for care coordination for BHT/ABA services.
What You Will Do...
resume-library.com -
Care Manager - BHI (LCSW, LPCC, LMFT, RN (with BH experience), Board Certified Behavioral Analyst...
Equiliem-Orange
from behavioral health providers. They are also responsible for utilization management, quality reviews and monitoring activities of BHT services. The Care Manager will directly interact with providers for care coordination for BHT/ABA services.
Duties...
resume-library.com -
Impresiv Health-Orange
by communicating the Medical Director's decision and documents follow-ups in the utilization management system.
Completes required documentation for data entry into the utilization management system at the time of the telephone call or fax to include any...
resume-library.com -
Pyramid Consulting, Inc-Orange
and telephonically to coordinate member care.
Conduct discharge planning. Educate providers on utilization and medical management processes.
Provide clinical knowledge and act as a clinical resource to non-clinical team staff.
Enter and maintain pertinent...
resume-library.com -
Equiliem-Orange
information prior to submission to the Medical Director, follows up with the requester by communicating the Medical Director’s decision and documents follow-ups in the utilization management system.
Completes required documentation for data entry...
resume-library.com -
JobTracks, Inc.-Orange
and outpatient utilization management systems focused on behavioral health and Substance Use Disorders
Develop, operationalize and manage inpatient and outpatient case management systems focused on behavioral health and Substance Use Disorders
Develop...
resume-library.com -
Equiliem-Orange
Minimum Qualifications:
High School diploma required.
5 years of health care/managed care experience required. Preferably in the following related areas of responsibility: Grievances and Appeals, Utilization Management and/or Quality Management...
resume-library.com -
Impresiv Health-Orange
applicable to the position assignment.
You have knowledge of:
Guidelines and regulations relevant to case management and utilization management.
Confidentiality and the legal and ethical issues pertaining to case management.
National Committee...
resume-library.com -
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