- Magellan Health Services (Boise, ID)
- …implement solutions that directly influence quality of care . General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work ... + Maintains an active work load in accordance with National Care Manager performance standards. + Works with community agencies as appropriate. Proposes… more
- Elevance Health (Durham, NC)
- …and depression, and insightful analytics to improve the delivery of care . **BH Care Manager I, UM /Crisis Line - North Carolina** Candidate must live ... or 7:30 am to 8 pm (EST) and Rotating Holiday coverage.** The **BH Care Manager I, UM /Crisis Line** is responsible for managing psychiatric and substance… more
- Elevance Health (FL)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... + Will serve as a resource to other BH Care Managers. + Assists with more complex cases and...if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis… more
- The Cigna Group (Bloomfield, CT)
- …position is a licensed professional with a background in the insurance industry as a care manager in a behavioral healthcare role, or an individual who has ... service as a mental health or chemical dependency counselor. As an Inpatient Care Manager at Evernorth, you will use your clinical knowledge and skills to… more
- Sharp HealthCare (San Diego, CA)
- …, as it related to the position.Bring to attention of the Supervisor, Utilization Management Care Coordinators, and UM Manager , areas of UM ... position, and employer business practices. **What You Will Do** The UM Care Coordinator, under the direct supervision of the Supervisor, Utilization Management… more
- Integra Partners (Troy, MI)
- …educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The ... of the Operations training and development program. The Operations UM Training Specialist will work in collaboration with Operations...but are not limited to: + Works with the Manager of Operations Training to develop an end-to-end training… more
- Humana (Columbus, OH)
- …support for the policies and procedures ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2 + Support ... and arrange a safe facility discharge. + Work with UM Nurses, Pharmacy, Medical Directors and other Departments. +...in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** **Required… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …regarding their requests for preservice, prospective, and concurrent reviews. The Senior UM Coordinator reports to the Manager , Utilization Management and/or ... Plan Solutions provides Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by performing data collection, data… more
- LifePoint Health (Las Cruces, NM)
- …local law./ **Job:** **Nursing* **Organization:** **Memorial Medical Center* **Title:** *RN Case Manager - UM - PRN* **Location:** *New Mexico-Las Cruces* ... Memorial Medical Center is a 199-bed hospital offering a spectrum of care , including diagnostic, therapeutic, and rehabilitative services, both on an inpatient and… more
- ManpowerGroup (Columbia, SC)
- + **Title:** Managed Care Coordinator UM II + **Location:** Initial on-site work required for the first week, followed by remote work. + **Hours:** ... Identify and make referrals to appropriate staff (eg, Medical Director, Case Manager , Preventive Services, etc.). + Participate in data collection/input into the… more
- Elevance Health (Grand Prairie, TX)
- …limited to: + Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, ... medical policy and industry standards, accurately interpreting benefits and managed care products, and steering members to appropriate providers, programs or… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …understanding of behavioral health resource management to review and coordinate the care for a designated patient caseload. Collaborates with the attending LIP, ... Clinical Case Manager , nurse, and other members of the treatment team,...and utilization review principles in monitoring the delivery of care and promoting optimal communication among treatment team members,… more
- Elevance Health (Indianapolis, IN)
- …use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient ... medical policy and industry standards accurately interpreting benefits and managed care products and steering members to appropriate providers, programs or community… more
- InnovaCare (San Juan, PR)
- …Management Inpatient Coordinator.14. Prepares and submits to the Health Services Department / UM Medical Care Manager a monthly report of activities ... the position as requested by the Health Services Department Inpatient Medical Care Manager .18. Documents the discharge data in the Daily Census module MedHOK… more
- Elevance Health (Seven Fields, PA)
- …of cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. + Hires, trains, coaches, counsels, and ... ** Manager II Behavioral Health Services** **Location:** This position...across departments to ensure cost effective and quality member care . + Additional responsibilities for integrated BH UM… more
- LA Care Health Plan (Los Angeles, CA)
- …needs of LA Care 's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager /Director ... is responsible for executing the day-to-day operations of the UM department, and monitoring the Care Management...of the UM department, and monitoring the Care Management (CM) staff's responsibilities and activities. This includes,… more
- LA Care Health Plan (Los Angeles, CA)
- Manager , Medical Management Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID: ... $152,762.00 (Mid.) - $188,015.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created...net required to achieve that purpose. Job Summary The Manager of Medical Management is responsible for the overall… more
- Cleveland Clinic (Vero Beach, FL)
- Under the general supervision of the UM Team Manager , this individual performs UM activities which includes admission review, concurrent review, ... special projects which are coordinated and directed by the UM Team Manager . May design and initiate...recommendations based on findings. + Knowledge and experience with Care Guidelines, Medical Necessity Criteria and/or other UM… more
- UNC Health Care (Raleigh, NC)
- …health and well-being of the unique communities we serve. **Seeking full-time on-site RN Care Manager to work a variable schedule of 4- 10-hour days ... of case management, utilization review and discharge planning. The Care Manager must be highly organized professional...CAPP as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting… more
- UNC Health Care (Chapel Hill, NC)
- …and functions of case management, utilization review and discharge planning. The Care Manager must be highly organized professional with great attention ... (EDD). Complete follow-up from CAPP as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting to discuss updates and action… more