- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case Management - Day (Temporary) Location: WellSpan Health, York, PA Schedule: Full Time Schedule Temporary Role ... WellSpan's geographic footprint. General Summary Performs a variety of reviews and applies utilization and case management techniques to determine the most… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families,...Identify and refer members who may benefit from high-risk case management and disease state management… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review, billing, or coding experience ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- Molina Healthcare (Bothell, WA)
- …Plan. We are seeking a candidate with a WA state LPN licensure. Candidates with case management , Utilization Management (UM), and direct managed care ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of care Referrals, etc.).… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/ case management /clinical/or combination; 2 of ... work independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience… more
- UTMB Health (Friendswood, TX)
- …ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/ Case Management program by utilizing clinical ... + Supervises the operational management of the Utilization Review/ Case Management program to...Standard office equipment. **_WORK ENVIRONMENT_** **:** + May involve travel . + May involve occasional shift work and weekends… more
- Houston Methodist (Baytown, TX)
- …(MSW) + Master's in nursing preferred **WORK EXPERIENCE** + Five years experience in inpatient case management , social work or utilization management or ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
- Houston Methodist (The Woodlands, TX)
- …Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work department. This position is an integrated, ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
- ERP International (Nellis AFB, NV)
- …of care; and utilization of resources. Monitors and evaluates the facility's case management program per DoD, AF, DHA and local policies and guidelines. ... * Travel outside of the local MTF and/or off the...last 24 months o Experience in case management , condition management , discharge planning, utilization… more
- Health First (Melbourne, FL)
- …in a acute care hospital. * Knowledge/Skills/Abilities: o Knowledge of care transitions, utilization management , case management , performance improvement ... 3. Practices autonomously, consistent with evidence-based standards. 4. Serves as a case management resource expert for compliance with Medicare IM letter,… more
- State of Massachusetts (Taunton, MA)
- …least four (4) years of full-time, or equivalent part-time, case management of clinical/therapeutic experience. Based on assignment, travel may be required. ... seeking a dynamic candidate to be the Southeast CYF Case Management Supervisor, Human Services Coordinator II...HSC II has the responsibility of monitoring performance and utilization of assigned Area or Site-based CYF contracts and… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management ... and social work department staff to facilitate efficient utilization of resources and discharge planning. This position performs...of duties of a higher complexity in support of Case Management operations including referrals management… more
- Swedish Health Services (Seattle, WA)
- …Shift:** Multiple shifts available **Career Track:** Admin Support **Department:** 3900 SS Case Management **Address:** WA Seattle 1115 Columbia St **Work ... creating and maintaining filing systems; scheduling meetings and arranging travel ; entering, extracting, and analyzing data into reports and presentations;… more
- United Therapeutics (Columbus, OH)
- …pulmonary diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management and ... processing for commercial UT products, including PM GSD workflows; Maintain unified PM Case Management operating procedures and monitor systems to ensure all PM… more
- LifePoint Health (Rutherfordton, NC)
- …knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of Case ... Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization ...from admission through discharge. Educates Physicians and staff in Case Management standards and assists them in… more
- CenterWell (Las Vegas, NV)
- …and help us put health first** **The Role** 10k sign on bonus** The Manager Care/ Case Management is responsible for managing a team of nurses, community health ... and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel.../ license + 5 years or more prior nursing, case management , disease management and/or… more
- Houston Methodist (Houston, TX)
- …for state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement ... Methodist hospitals + Mileage reimbursed + Magnet - ANCC Recognized Certification -- Case Management -related **OR** ACM - Accredited Case Manager (NBCM)… more
- Houston Methodist (Sugar Land, TX)
- …for state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement ... PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This… more
- CVS Health (Tallahassee, FL)
- …full continuum of our members' health care and social determinant needs. The Case Management (CM) Medical Director will participate in designing, developing and ... one. **Primary Duties and Responsibilities:** * Provides clinical oversight of the case management teams and the Interdisciplinary Care Team (ICT) processes… more