- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Centene Corporation (Jefferson City, MO)
- …5+ years of related experience. 2+ years supervisory experience preferred. Knowledge of utilization management principles preferred. ... Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and… more
- Molina Healthcare (NV)
- …of illness and the site of service. ** KNOWLEDGE /SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of ... not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management /… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... + Thorough knowledge of health care industry, utilization review, utilization management , and...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Magellan Health Services (Honolulu, HI)
- …criteria for RN, Masters or Doctoral level provider. General Job Information Title Manager , Clinical Care Services ( Utilization Management - BH), Must ... and leading a team of 5-8 team members. Candidates must have experience in utilization management within behavioral health to be considered for this role.… more
- Trinity Health (Fresno, CA)
- …services rendered while supporting the healing mission of Saint Agnes Medical Center. The Manager Utilization Management will ensure the timely delivery of ... , leadership, and coordination of the departments of the Utilization Manager Team to ensure payor reimbursement...utilization review, discharge planning and support case management and the psychosocial services to patients, families, and… more
- Trinity Health (Silver Spring, MD)
- …setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years clinical ... with the Nursing Director and Sr. Director of Care Management + Conduct clinical supervision with all case managers...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Guidelines (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) -… more
- Molina Healthcare (Lexington, KY)
- …including 3 or more years in one or more of the following areas: utilization management , case management , care transition and/or disease management ... + Experienced **Product** Owner - Managing requirements, testing and implementation for Utilization Management platforms required; Pega UM preferred (5+yrs) +… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Stanford Health Care (Palo Alto, CA)
- …Collaborates with the UM/CM Medical Director team on complex cases. + Ensures Utilization Management staff maintains up-to-date knowledge , skills, and ... onsite Stanford Health Care job.** **A Brief Overview** The Dir- Utilization Management (UM) leads and shapes the... experience + Five (5) years of progressively responsible management experience **Required Knowledge , Skills and Abilities**… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …in program planning, implementation, staff development, and needs assessment + Comprehensive knowledge of utilization management , financial management ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… more
- Healthfirst (NY)
- … management , identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes:...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Sutter Health (Burlingame, CA)
- …delivery and case management within a managed care environment. Comprehensive knowledge of Utilization Review, levels of care, and observation status. ... **Organization:** Bay Administration **Position Overview:** Responsible for Utilization Management and accurate bed placement for patients coming in from the ED.… more
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/170050/case- manager utilization - management ... or management , preferred. + Current BCLS certificate preferred. + Knowledge of Milliman Criteria and InterQual Criteria preferred. West Anaheim Medical Center… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/168695/case- manager utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- GEHA (Lee's Summit, MO)
- …customer experience, sustained by a nimble and efficient organization. The Utilization Management and Oversight Pharmacist will assist with corporate ... effort to make our insurance product more competitive and support growth. The Utilization Management and Oversight Pharmacist widely supports the operation of… more
- Catholic Health (Lockport, NY)
- …or Disease Manager , Population Health , Discharge Planning or Chronic Care Manager KNOWLEDGE , SKILL AND ABILITY + Strong clinical assessment skills and ... Holiday Rotation Hours: 8:00a-4:00p, 9:00a-5:00p, 10:00a-6:00p, 11:00a-7:00p Summary: The RN Care Manager , Utilization Review/ Transitions of Care, as an active… more
- Hartford HealthCare (Torrington, CT)
- …moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager (LCSW) - ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- LA Care Health Plan (Los Angeles, CA)
- … Knowledge of state, federal and regulatory requirements in Care/Case/ Utilization Management . Strong verbal and written communication skills. Computer ... Supervisor, Utilization Management RN Job Category: Clinical...Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager /Director… more