- Queen's Health System (Honolulu, HI)
- RESPONSIBILITIES I. JOB SUMMARY/RESPONSIBILITIES: * Performs administrative support and program administration for the coordination of the daily operations of the ... Care Coordination/CDI and UM departments. II. TYPICAL PHYSICAL DEMANDS: * Essential: seeing, hearing and speaking. * Continuous: standing, sitting, walking,… more
- Integra Partners (Troy, MI)
- …to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations and claims ... educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes.… more
- ManpowerGroup (Columbia, SC)
- …health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review/ case management /clinical/or combination; 2 of 4 years must ... **Title:** **Managed Care Coordinator UM II** **Location: Columbia SC (Onsite)** **Duration: 3...Bachelor's degree- Nursing Preferred Work Experience: 7 years-healthcare program management . Preferred Licenses and Certificates: Case Manager… more
- Kepro (AR)
- …related to the applicable contract. The Oral Surgeon Physician Reviewer will support the dental UM contract for Arkansas Medicaid. Job Responsibilities: ... public sector. Acentra is looking for an Oral Surgeon ( UM Reviewer) to join our growing team. Job Summary:...case consultations as needed. + Discuss complicated Utilization Management reviews or clinical scenarios with Utilization Management… more
- Healthfirst (NY)
- …area of the healthcare industry working in a Call Center environment or Care/ Case Management Department + Experience navigating multiple technologies including a ... + Manage requests from members, providers, call centers and care management teams regarding initial authorizations, authorization updates and/or corrections +… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …to ensure appropriate utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in ... and professionalism by participating in educational opportunities with focus on case management , psychiatric and/or additional treatment issues/trends. +… more
- Molina Healthcare (Seattle, WA)
- …psychology, gerontology, public health or social work. **Required Experience** + 1-3 years in case management , disease management , managed care or medical or ... applicable state or locality with reliable transportation. **Preferred Experience** 3-5 years in case management , disease management , managed care or medical… more
- Stanford Health Care (Palo Alto, CA)
- …of care guidelines and utilization management principles. + Experience in case management , utilization review, or related healthcare roles. + Strong clinical ... Stanford Health Care job.** **A Brief Overview** The Utilization Management Registered Nurse ( UM RN) will be...- State Licensure and/or Compact State Licensure required + Case Management Certification (CCM) Within 2-years of… more
- University of Michigan (Flint, MI)
- CASE Director of Student Support Services (Hybrid) Apply Now **How to Apply** Please note: This is an internal search limited to current employees of the ... the Comprehensive Benefits for Faculty and Staffflier (https://hr.umich.edu/sites/default/files/benefit-highlights.pdf) . UM -Flint offers tuition support for eligible … more
- ERP International (Camp Pendleton, CA)
- …using inpatient, outpatient, onsite and telephonic CM * Develop and implement tools to support case management , such as those used for patient identification ... resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management...and outcome measures. + Develop and implement tools to support case management , such as… more
- Sharp HealthCare (San Diego, CA)
- …hospitalists rounds, as required, to discuss high risk patients requiring case management follow up.Attends clinical in-services or required operational/clinical ... utilizing designated computer systems.Complies with contracted health plan requirements for case management activities performed in a manner consistent with… more
- Guthrie (Sayre, PA)
- …operational outcomes in timely, coordinated, and cost- effective manner. The Manager-of Case Management supports utilization management , discharge planning, ... Summary Provides day- to day operational leadership, oversight, and support to the Acute Case Managers, social...scope of practice within the department. . . The Manager- Case Management collaborates cooperatively with members of… more
- CVS Health (Dover, DE)
- …in UM activities as needed by the market including but not limited to UM case reviews, member and provider appeals Participate in an on call schedule as ... of members' Individual Care Plans (ICP) and assisting care management staff as they support of members' physical, behavioral and socioeconomic needs. * Partner… more
- Omaha Children's Hospital (Omaha, NE)
- …team to assess for diagnosis, care needs, and discharge plans. * Introduces Nurse Case Management (NCM) role to family. * Completes NCM assessment and documents ... and processes. + Communicates and collaborates with the Utilization Management ( UM ) Nurse, or other NCMs as...and placement, as applicable. + Monitors system to report case management outcomes and works as a… more
- Omaha Children's Hospital (Omaha, NE)
- …team to assess for diagnosis, care needs, and discharge plans. + Introduces Nurse Case Management (NCM) role to family. + Completes NCM assessment and documents ... and policies. + Communicates and collaborates with the Utilization Management ( UM ) Nurse, or other NCMs as...and placement, as applicable. + Monitors system to report case management outcomes and works as a… more
- UNC Health Care (Raleigh, NC)
- …continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Care Manager ... **Job Details** Legal Employer: NCHEALTH Entity: UNC REX Healthcare Organization Unit: Rex Case Management Services Work Type: Full Time Standard Hours Per Week:… more
- BronxCare Health System (Bronx, NY)
- …participation includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in ... and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients,… more
- ERP International (Lemoore, CA)
- …using inpatient, outpatient, onsite and telephonic CM * Develop and implement tools to support case management , such as those used for patient identification ... resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management...management program. Increase MTF staff involvement in and support of case management initiatives… more
- ERP International (Twentynine Palms, CA)
- …using inpatient, outpatient, onsite and telephonic CM * Develop and implement tools to support case management , such as those used for patient identification ... **Overview** ERP International is seeking **Registered Nurse (RN) Case Managers** for full-time positions in support...resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management… more
- Covenant Health (Nashua, NH)
- …Conditions + Educates patients and families on the concept, process, and goals of case management . + Educates patient and families on the treatment plan and ... education of the interdisciplinary team related to the individual patient case management goals, InterQual criteria and coverage determinations, multi-system… more