- 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 ... knowledge of health care industry, utilization review, utilization management , and concurrent review...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… 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
- Dignity Health (Phoenix, AZ)
- …Arizona and Nevada markets. Must have current Arizona unrestricted RN license.** The Utilization Management (UM) Manager is responsible for managing ... medical necessity determinations; processes appeals and reconsiderations. Act as a working manager within Utilization Management , performing essential duties… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… 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
- 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. + Conducts... review process. + Conducts admission reviews. + Conducts concurrent and extended stay reviews. + Prepares and submits… more
- Fallon Health (Worcester, MA)
- …a Registered Nurse in a clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care payer preferred. + One year ... by the Manager + Refers high-risk cases to the Case Management Department, Government Services Clinical Programs, Fallon Clinic Care Coordination + Department… 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
- 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
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/199249/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
- 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
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200415/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
- 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 (St. Petersburg, 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
- 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
- Dignity Health (Santa Maria, CA)
- …effectively with multiple stakeholders * Professional communication skills * Understand how utilization management and management programs integrate. * ... utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Beth Israel Lahey Health (Plymouth, MA)
- …years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding ... related to the care provided to the hospitalized patient. + Conducts concurrent reviews to determine the continued need for acute care setting, appropriateness… more
- Houston Methodist (Houston, TX)
- …+ Provides leadership to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...and other areas according to department specifications. + Manages utilization management (UM) programs including Medical Claims… more