- Fresenius Medical Care (Olmito, TX)
- …medical practices and procedures meets applicable standards. Ensures provision of quality patient care and the role is responsible to the ASC Governing Body for ... and for operational oversight. PRINCIPAL DUTIES AND RESPONSIBILITIES: Environment of Care & Quality . Manage site employees, environment, clinical processes and… more
- AlliedTravelCareers (Greenbrae, CA)
- …RN Case Manager with experience as follows: Must have strong Utilization Review and InterQual experience REQUIRED! Conducting patient initial assessments ... Friday - 0730 to 1600 Specialty Type: Nursing Sub Specialties: Care Manager , MRI Technologist General Certifications: General Certifications(BLS/BCLS) Please… more
- UPMC (Pittsburgh, PA)
- …to candidates located in Pennsylvania. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... is looking for you! We are hiring a full-time Utilization Management Care Manager to...information obtained from interaction with members and providers. + Review and document clinical information from health care… more
- Wellpath (Franklin, TN)
- …**About this role** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across ... or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to ... reimbursement requirements. Serves as a resource to the health care team for utilization and denial management....required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...employed physician advisors to support decision-making and adherence to care standards. + On-site Review Preparation: Assists… more
- Logan Health (Kalispell, MT)
- …lead the way as our Manager of Clinical Documentation Integrity (CDI) & Utilization Review ! This role is ideal for a collaborative RN leader who understands ... compassion. Make a system-wide impact! Our Mission: Quality, compassionate care for all. Our Vision: Reimagine health care...workflows with clarity. What You'll Be Doing: As the Manager of CDI & Utilization Review… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Cedars-Sinai (Los Angeles, CA)
- …more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the ... and contribute to our mission of providing word-class health care and the best quality service to our patients...ID** : 14141 **Working Title** : Registered Nurse - Utilization Review Case Manager -… more
- UNC Health Care (Hendersonville, NC)
- …daily with the Care Manager to manage level of care transitions & appropriate utilization of services. Coordinates with the appropriate staff/payers ... the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge … more
- Highmark Health (Harrisburg, PA)
- …SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... consistent with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred. +… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case- manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- Intermountain Health (Las Vegas, NV)
- …The Manager of Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department ... triage, and coordination with compliance and legal to support care delivery. The Manager Care ...experience. **Preferred Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …cost containment, peer review and rehabilitation; + May notify acute care hospitals of scheduled utilization review including conducting second ... with Disabilities Act (ADA), please contact Edward Magnano, EEO Manager at (860) 418 - 6148 or ###@ct.gov PURPOSE... review and rehabilitation; + May notify acute care hospitals of scheduled utilization review… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Helio Health Inc. (Syracuse, NY)
- …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Community Health Systems (Franklin, TN)
- …appeals activities, and collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors ... 2-4 years of clinical experience in utilization review , case management, or acute care nursing...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more
