- Centene Corporation (Olympia, WA)
- …experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred. ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management ** is a member of the healthcare team ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Holmdel, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The **Care Coordinator , Utilization Management ** is a member of the healthcare team ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Hackensack, NJ)
- …healthcare and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Prime Healthcare (Boonton Township, NJ)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/172970/ utilization -review- coordinator -%28pd%29/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... managers and managed care organizations for pre-authorization, concurrent reviews and appeals /denials management throughout the duration of a consumer's stay.… more
- Huron Consulting Group (Chicago, IL)
- …the utilization management system. + Generate and analyze reports on utilization trends, denials, and appeals to identify areas for improvement. + Ensure ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...discussions. + Hold weekly 1:1 meetings with the Senior Coordinator and conduct Staff 1:1's to provide support and… more
- Elevance Health (KS)
- …(such as LTSS/IDD), behavioral health or physical health needs. + Submits utilization /authorization requests to utilization management with documentation ... to, potential for high-risk complications). + Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams… more
- Corewell Health (Dearborn, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Responsible for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning… more
- Corewell Health (Grosse Pointe, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Responsible for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning… more
- TEKsystems (Fountain Valley, CA)
- …and Inter-Rater Reliability audits to meet regulatory compliance as it pertains to utilization management activities * Acts as educator and resource to medical ... Description: The Compliance Coordinator is a key leadership support position designed... management experience, especially in the area of Utilization Management and Health Plan audits *… more
- Elevance Health (Pittsburg, KS)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... in-person with patients, members or providers. The **Foster Care - Service Coordinator (** **LTSS SERVICE COORDINATOR )** is responsible for conducting service… more
- Elevance Health (New Hyde Park, NY)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... **LTSS Service Coordinator ** _Location:_ This is a hybrid role. Candidate...plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS… more
- Mohawk Valley Health System (Utica, NY)
- Registered Nurse - MDS Coordinator - Regular Hours - Days Department: UTILIZATION SERVICES Job Summary The RN - MDS Coordinator will play a crucial role in ... of daily Medicare documentation and Medicare (re)certifications. + Initiates and monitors appeals to Livanta. + Prepares CMI (Case Mix Index) calculations and… more
- Nuvance Health (Poughkeepsie, NY)
- …for appeals , following processes established by the Health Information Management Department. 5. Assists in timely sorting and disseminating requests for medical ... *Description* Purpose: The Operations Coordinator , with a high degree of autonomy, will...execution of equipment procurement. 2. Runs and prepares Case Management reports and assists with creating presentations for monthly… more
- CareOregon (Portland, OR)
- …Arizona, Nevada, Texas, Montana, or Wisconsin. Position Title: Pharmacy Benefit Coordinator II Exemption Status: Exempt Department: Pharmacy Title of Manager: ... oversight and maintenance for the day-to-day operations of pharmacy benefit management for key lines-of-business, clients and/or initiatives. There is a particular… more
- Providence (OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... them.** **Providence Health Plan is calling a Clinical Program Coordinator RN who will:** + Provide care coordination, case... RN who will:** + Provide care coordination, case management and care management services to Providence… more
- Rush University Medical Center (Chicago, IL)
- …managers, community providers, payers and internal/external agencies to provide case management support services related to effective utilization of services ... Provides designated support for functions including payer approval / certification communication, denial appeals , and / or level of care management processes. *… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- … Utilization Review Nursing Staff, Medical Directors, Medical Necessity Appeals , Administrative Appeals , Pharmacy and Providers staff. **QUALIFICATIONS** ... targets for staff and unit performance as required by company and management standards to ensure achievement of departmental productivity goals + Receives member… more