- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the ... assess and make recommendations for improvements to maintain an effective and efficient utilization management process, as well as manage medical expenses based… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; participates in ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness… more
- VNS Health (Manhattan, NY)
- …and updates through on-going training, coaching and educational materials. + For Utilization Management Only: + Issues Determinations, Notices of Action, and ... health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical...by state or federal regulations are saved in the Utilization Management System. + Reviews, evaluates and… more
- Banner Health (AZ)
- …team format. PREFERRED QUALIFICATIONS Previous experience with behavioral health utilization management . Additional related education and/or experience ... experience and skills to BPN. As a Behavioral Health Utilization Care Manager , you will be assigned...hospitals where you will authorize initial admitting and do concurrent reviews for medical necessity. You will be working… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- UCLA Health (Los Angeles, CA)
- …Nursing staff) + CA RN License and BLS certification + Recent experience in case management , utilization management and discharge planning + Minimum of three ... care for a diverse group of patients. This in-patient utilization review case manager position will work...coordination of care. In this role you will perform utilization review while assuring the delivery of concurrent… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- UPMC (Hanover, PA)
- …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...information for JCAHO requirements. + Takes leadership role in concurrent denial process. Works with Care Management … more
- Hackensack Meridian Health (Hackensack, NJ)
- … Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review, utilization management , and concurrent and retrospective review process. c. ... direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight...documentation e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate… more
- Hackensack Meridian Health (Hackensack, NJ)
- … Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review, utilization management , and concurrent and retrospective review process. c. ... direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- McLaren Health Care (Port Huron, MI)
- …setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the...the principles, methods, materials, and equipment necessary in providing utilization management services. * Demonstrated expertise in… more
- McLaren Health Care (Detroit, MI)
- …setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay… more
- Hackensack Meridian Health (North Bergen, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Dignity Health (Northridge, CA)
- …(PRO), Joint Commission, and payer defined criteria for eligibility. + Understand how utilization management and management programs integrate. + Reviews the ... care centers. Visit dignityhealth.org/northridgehospital for more information. Northrdige Hospital Utilization Review RN Utilization Review Responsible for the… more
- Lawrence General Hospital (Lawrence, MA)
- … utilization and quality trends and make recommendations to management on improvement opportunities. DUTIES AND RESPONSIBILITIES: + Ensures efficient and ... parties to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatients in a...acute care setting with discharge planning, continuing care, care management , and utilization review. + Five years… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189319/case- manager %2c-rn utilization ... 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
- LifePoint Health (Brentwood, TN)
- …do:* Manages and directs the development and implementation of a Centralized Utilization Management Program across multiple hospitals (systems). Develops and ... each entity. *Responsibilities:* * Oversee the development, implementation, and performance management of Utilization Review services across Lifepoint Health. *… more
- Covenant Health Inc. (Louisville, TN)
- …budgeted targets. + Provides medical/psychiatric leadership/consultation to Provider Relations, Medical Utilization Management , and Quality Management Staff ... of physicians on updated utilization review guidelines. + Participates in Utilization Management Committee. + Performs other related duties as required.… more
- BayCare Health System (Clearwater, FL)
- …and Licensures:** + Required RN (Registered Nurse) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager ) **Education:** + Required Associates ... of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities include:** + Functions as the… more
- University of Utah Health (South Salt Lake, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more