- Point32Health (MA)
- …to improve outcomes of assigned services such as CM and UM ( Utilization Management ). The Clinical Program Manager works directly and regularly with ... we are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Program Manager is a Registered Nurse who performs program … more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager...as SME for clinical components of the OH Medicaid Utilization Management Program . Works in ... CMS Program Audit and Compliance/Internal audits, pertaining to the OH Utilization Management program . + Act as a primary liaison with plan providers… more
- Amazon (Seattle, WA)
- …to own them to completion. We're seeking an experienced Senior Technical Infrastructure Program Manager in Seattle, WA to oversee data center electrical ... projects. You will lead cross-functional and technical teams identify sub-optimal utilization , determine root causes, design solutions and drive project delivery.… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... + **Advancement:** Opportunities to advance through the Clinical Advancement Program + **Location:** Holy Cross Health has two hospitals...- 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible… more
- LifeCenter Northwest (Bellevue, WA)
- …for improvement. + Hire and staff the OUCT team and collaborate with the Organ Utilization Program Manager (OUPM) with new hire onboarding for OUCT staff ... for cost management . + Work in concert with Director, Organ Utilization , OUPM, Surgical Recovery Manager , Surgical Organ Recovery Specialist(s), Organ… more
- UNC Health Care (Hillsborough, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...October 1, 2015, must be enrolled in an accredited program within four years of employment, and obtain a… more
- ERP International (Corpus Christi, TX)
- …staff, executive staff, newcomers, as appropriate. * Participate in all phases of the Utilization Management Program (UMP) and ensure that the UMP meets ... **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager ** for a full-time position in...established Utilization Management (UM) standards of care. Assist… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program ... a particular department/unit. This includes, but is not limited to, the management of: + Program -specific applications, quality improvement, staff education,… more
- Catholic Health Initiatives (Lexington, KY)
- …is responsible for the market(s) development, implementation, evaluation and direction of the Utilization Management Program and staff in support of the ... CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and continued stay reviews,… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...or supervisory experience. Equivalency: Completion of the LA Care Management Certificate Training Program may substitute for… more
- Hartford HealthCare (Torrington, CT)
- …moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager (LCSW) - ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- Hackensack Meridian Health (Hackensack, 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 ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...and refers quality issues for review to the Quality Management Program + Participates in multidisciplinary rounds,… more
- Hackensack Meridian Health (Holmdel, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...and refers quality issues for review to the Quality Management Program . + Participates in multidisciplinary rounds,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to...and refers quality issues for review to the Quality Management Program . + Participates in multidisciplinary rounds,… more
- Acacia Network (Bronx, NY)
- Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job ID#: 3904 Job Category: Acacia Network Inc. Position Type: Full Time Details: ... scheduled. + Acting as a liaison between the residential program and the MCO to better facilitate the reimbursement...Degree preferred) + Minimum of 2 years of case management and/or utilization review experience + Strong… 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 ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates,...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Humana (Louisville, KY)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and… more
- HCA Healthcare (Campbell, CA)
- …purpose and integrity. We care like family! Jump-start your career as a(an) Utilization Management RN today with HCA Healthcare. **Benefits** HCA Healthcare, ... student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program ...vary by location._** Come join our team as a(an) Utilization Management RN. We care for our… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more