- Elevance Health (GA)
- ** Telephonic Nurse Case Manager I - $3000 Sign-On Bonus Offered** **Location: This is a virtual position, but you must reside in the State of Georgia.** **Work** ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager I** is responsible for telephonic care management… more
- Elevance Health (Tampa, FL)
- ** Telephonic Nurse Case Manager Senior** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager Senior** is responsible for care management within the scope… more
- Elevance Health (Norfolk, VA)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
- Elevance Health (Palo Alto, CA)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Prefer candidates reside in a PST or MST state and within 50 miles of an Elevance Health ... members in different states; therefore, Multi-State Licensure will be required.** The ** Telephonic Nurse Case Manager II** is responsible for care management within… more
- LA Care Health Plan (Los Angeles, CA)
- …referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and ... Utilization Management Nurse Specialist LVN II Job Category:... review or input and presents for physician review if indicated. Perform telephonic and/or on… more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
- HCA Healthcare (Campbell, CA)
- …years of experience in Managed Care, Provider Office, or Utilization Review organization required Physician Services Group ... been identified as high risk for hospital readmissions through telephonic case management Perform other duties as assigned **What...personal growth, we encourage you to apply for our Utilization Management RN opening. We promptly review … more
- Banner Health (AZ)
- …and services to meet the member's health care needs. This position provides telephonic or electronic document review . This position engages internal and external ... work settings. In the role of a Behavioral Health Utilization Care Manager, you will be tasked with assignments...SUMMARY This position is the point person for all utilization activities for assigned members. As part of an… more
- Point32Health (MA)
- …Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Provide behavioral health utilization review and care management in order to ensure ... plans of treatment. Work as a member of one of the Concurrent Review Team. **Key** **Responsibilities/Duties** **- what you will be doing** Coordinate the delivery… more
- Fallon Health (Worcester, MA)
- …Provide clinical support for prior authorization process + On-site, off-site and telephonic inpatient case management rounds + Outpatient case management rounds + ... Provider appeals review + Member appeals review + Pharmacy...licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management; network management; medical policy and technology experience.… more
- Spokane County (Spokane, WA)
- …Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - ... and discharges or lack of movement toward discharge. + Collaborates with Utilization Review Integrated Care Coordinator regarding continued inpatient stay… more
- The Cigna Group (Philadelphia, PA)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
- Ventura County (Ventura, CA)
- …Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and ... experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and… more
- Kepro (Chicago, IL)
- …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. . Mentoring, coaching, and training team members ... Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams...(CCM). + Analytical, reporting, and data management skills. + Telephonic case management and/or triage experience. + Knowledge of… more
- WellSpan Health (York, PA)
- …with the CM leadership team in developing and maintaining CM policy including, Utilization Review , Social Services and Clinical Case Management. + Identifies ... Management in the provision of leadership and integration of utilization management principles throughout the Hospital. Duties and Responsibilities Essential… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
- Highmark Health (Columbus, OH)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- CommonSpirit Health (Sacramento, CA)
- …community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred ... with the hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This position will be a part of the… more
- Atlantic Health System (Morristown, NJ)
- …the patient experience, achieve better health outcomes, decrease avoidable cost and utilization , and increase the utilization of preventative care and healthy ... needs, values, and goals of the patient. Provide individual telephonic /virtual support and counseling to patients, using appropriate therapeutic techniques… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more