- University Health (Pleasanton, TX)
- …(as a Staff nurse II or above). Work experience in case management, utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS Current ... POSITION SUMMARY/RESPONSIBILITIES The nurse case manager coordinates, in collaboration with the patient and...the patient and interdisciplinary team, the treatment/ plan of care for a patient within the acute episode of… more
- University Health (Boerne, TX)
- …recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance experience is preferred. ... POSITION SUMMARY/RESPONSIBILITIES Care Coordinator will be instrumental in assisting the...clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF… more
- University Health (Pleasanton, TX)
- …recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. ... of appropriate diversions to home or other level of care more appropriate for the services needed to be...nurse is required. National certification in related field is preferred. Case Manager Certification (CCM or ANCC) is highly… more
- UPMC (Pittsburgh, PA)
- …to candidates located in Pennsylvania. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and ... is looking for you! We are hiring a full-time Utilization Management Care Manager to...information obtained from interaction with members and providers. + Review and document clinical information from health care… more
- Wellpath (Franklin, TN)
- …make a difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across ... or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to ... reimbursement requirements. Serves as a resource to the health care team for utilization and denial management....required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... + Staff Acquisition and Support: Leads and manages the utilization review staff and function for the...employed physician advisors to support decision-making and adherence to care standards. + On-site Review Preparation: Assists… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...**Required Experience (must have):** + 2 to 3 years Utilization Management experience in a managed care … more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred. +… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236088/rn-case- manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the ... Utilization Management Manager Date Posted: Nov...achieve positive health outcomes through access to high quality care and services. You serve as the utilization… more
- Community Health Systems (Franklin, TN)
- …appeals activities, and collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors ... 2-4 years of clinical experience in utilization review , case management, or acute care nursing...Compact State Licensure required + CCM - Certified Case Manager preferred or + Accredited Case Manager … more
- Helio Health Inc. (Syracuse, NY)
- …+ Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care , or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Tenet Healthcare (Detroit, MI)
- …appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily, essential) ... RN Utilization Review - Case Management -...coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... to monitor appropriateness of admissions with associated levels of care and continued stay review . + Communication...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines...Case Manager (ACM-RN), or UM Certification + Utilization Review experience **Where You'll Work** Hello… more
- Ochsner Health (Jefferson, LA)
- …relationships, contract management, standardization and consolidation processes and utilization analysis. Reviews, analyzes, negotiates, and develops contractual ... cost reduction initiatives throughout the organization by serving as a project manager and consultant to the clinical and non-clinical areas; tracks the system… more
- Elevance Health (Tampa, FL)
- …health practitioners responsible for coordinating member service, utilization , access, care management and/or concurrent review to ensure cost effective ... law. *Must reside in the state of Florida* The ** Manager of Utilization Management** is responsible for...+ MSN, MPH, MPA, MSW or MBA with Health Care Concentration preferred. + Certified Case Manager … more
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