- Penn State Health (Hershey, PA)
- …PDF for more detailed steps for assistance._ **Union:** Non Bargained \#LI-TB1 **Position** Manager Utilization Management - DAY SHIFT - Utilization ... **SUMMARY OF POSITION:** Position is responsible to thoroughly understand all Utilization Management regulatory requirements for both CMS and DOH,… more
- Commonwealth Care Alliance (Boston, MA)
- CCA-Auth & Utilization Mgmt Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of Utilization ... licensed in Massachusetts. . Required Experience (must have): * 3-5 years utilization management experience * 3+ years' experience working in a health plan,… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with ... area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of...trusted provider of health services within our community. A Manager at Holy Cross Hospital is expected to demonstrate… 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 ... (BSN) degree required + Five or more years of utilization management required + Four or more...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Centene Corporation (Madison, WI)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent review, and retrospective clinical review team and ensures… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This ... quality issues or complaints, and/or approvals requiring next level authorization (eg, utilization management , high cost services, out of network services,… more
- Cleveland Clinic (Vero Beach, FL)
- … Manager . May design and initiate special projects as supervised by the Team Manager . Utilization Management Specialist Join our team at Cleveland Clinic ... Under the general supervision of the UM Team Manager , this individual performs UM activities which includes...of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities,… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Sutter Health (Sacramento, CA)
- …**Organization:** SHSO-Population Health Services-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that ... care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides third-party payers clinical information to assure… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/180750/case- manager -rn 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
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/181372/case- manager -%28rn%29 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
- 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 ... Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed… more
- Amazon (Herndon, VA)
- …them to completion. We're seeking an experienced Technical Infrastructure Program Manager to oversee data center electrical infrastructure optimization projects. You ... will lead cross-functional and technical teams identify sub-optimal utilization , determine root causes, design solutions and drive project delivery. Along the way,… more
- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- Guthrie (Cortland, NY)
- …safe discharge, based on assessed needs and available resources. The Acute Case Manager also performs Utilization Management throughout the continuum of ... Position Summary: This is an integrated Case Management and Utilization Review position. The Acute Care Case Manager utilizes industry accepted processes for… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... and Abilities** + Knowledge of principles and best practices of case management , utilization review, social work, care coordination and discharge planning.… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, ... Negotiates rates with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community resources to… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager , you will play a key role in processing ... role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the next level.… more
- Actalent (Los Angeles, CA)
- … Manager , Hiring Now!! Job Description Kaiser Permanente is seeking an RN Case Manager to provide utilization management of patients at the East Hollywood ... to $52/hour. Great opportunity to gain experience with Kaiser! Requirements + Utilization management experience + Valid CA RN License + Ability to work… 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 ... (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) - American Case … more