- CHRISTUS Health (Wake Village, TX)
- …nursing is required. Experience Minimum of two (2) years' experience in Case Management and/or Utilization Management is required. Licenses, Registrations, ... level of care of patients entering the CHRISTUS Health system to ensure the appropriate utilization of...errors are identified to maximize hospital reimbursement and resource utilization . * Responsible for 24/7 ongoing management … more
- Guthrie (Binghamton, NY)
- LPN - Utilization Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and ... payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have ... personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly...and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning… more
- Sharp HealthCare (San Diego, CA)
- …is bedded, during the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. ... while ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management . Expected outcomes… more
- MetroHealth (Cleveland, OH)
- …and Milliman Health Management Guidelines. Current working knowledge of, utilization management , case- management , performance improvement, and managed ... ethnic, racial, and socioeconomic backgrounds Preferred: 3 years of experience with a Utilization Management focus. Working knowledge of current utilization … more
- Stanford Health Care (Palo Alto, CA)
- …guidelines and utilization management principles. + Experience in case management , utilization review , or related healthcare roles. + Strong clinical ... onsite Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse (UM RN) will...ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization … more
- Magellan Health Services (Baton Rouge, LA)
- … management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. ... care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information… more
- Prime Healthcare (Reno, NV)
- …Us! (https://careers-primehealthcare.icims.com/jobs/182733/case-mgr-rn-pd-union smrmc- utilization - mgmt /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... orthopedic services, and an award-winning Cardiology program and more. The health system , a member of Prime Healthcare, also operates a fully-integrated Medical… more
- The Hartford (Alpharetta, GA)
- …a 100% in office position (Hartford, CT or Alpharetta, GA) that will perform Utilization Review for Work ers' Compensation Claims. An Initial Clinical ... to regulatory and ethics requirements. + Comply with URAC Workers' Compensation Utilization Management Standards and Policy and Procedures. + Comply with… more
- Prime Therapeutics (Columbus, OH)
- …- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... VP, Medical Affairs in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a… more
- ManpowerGroup (Columbia, SC)
- …States and in the state of hire. **Job Description:** As a Medical Claims Reviewer / Utilization Management Specialist, you will be responsible for conducting ... medical reviews using established criteria sets, performing utilization management of professional, inpatient or outpatient, facility benefits or services, and… more
- Medical Mutual of Ohio (OH)
- …years as a Registered Nurse with a combination of clinical and utilization /case management experience in pharmacy, medical/surgical, or psychiatric, preferably ... as well as Medicare Advantage, Medicare Supplement, and individual plans. Manages utilization of healthcare services to ensure the provision of safe, timely,… more
- Centers Plan for Healthy Living (Margate, FL)
- …preferably in a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals) Type of ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies + Communicates clearly and… more
- Trinity Health (Livonia, MI)
- …standards and deadlines. Data components will be obtained through the effective utilization of the hospital medical record system . + Demonstrates applicability ... the Information Systems Departments whose support is necessary for the management and success of the program. + Contacts patients and/or families via telephone… more
- Medical Mutual of Ohio (OH)
- …at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + ... consistent and quality health care services. + Keeps up to date on utilization management regulations, policies and practices. + If assigned to Preceptor/Trainer… more
- Hartford HealthCare (Hartford, CT)
- …through effective utilization of the hospital and surgeons' office record systems . . Works in collaboration with both clinical and administrative staff across ... and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable data to… more
- Medical Mutual of Ohio (OH)
- …state of Ohio. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Founded in 1934, ... and/or Customer Care Departments as applicable. *Keeps up to date on utilization management regulations, policies and practices, including applicable coding. *If… more
- Guidehouse (Reston, VA)
- …Do** **:** Guidehouse is seeking an Infrastructure Virtualization and Storage (IV&S) Technical Reviewer to join our team in the Northern Virginia area. In this role ... will be responsible for leading analysis, evaluation and integration of systems within the Intelligence Community Integrated Environment (IC IE). Responsibilities… more
- MyFlorida (Tallahassee, FL)
- …procedures. + Oversees OPPG software application which includes public guardianship management database and client management system ; registration; ... OPERATIONS & MGMT CONSULTANT II - SES - 65000379 (DEPUTY...Assist with workloads, workflows, deadlines, work objectives and time utilization with OPPG employees. + Review and… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... influence and direct the delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure the most appropriate… more
