- Prime Healthcare (Ontario, CA)
- …(https://careers-primehealthcare.icims.com/jobs/172723/corporate- director -of-clinical- utilization - management ... Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management… more
- Prime Healthcare (Inglewood, CA)
- …credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/189094/ director -of-case- management utilization - management ... Privacy Notice for California Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Director of Case Management is responsible… more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Director of Case Management and Utilization Management Location: Dallas - Hospital Additional ... Details: Monday - Friday 8:00am to 4:30pm Job Description: Duties/Responsibilities: + Utilization Management supporting medical necessity and denial prevention +… more
- Ascension Health (Tulsa, OK)
- **Details** + **Department:** Utilization Management + **Schedule:** FT, Monday-Friday, 8am-5pm + **Hospital:** Ascension St. John Medical Center + **Location:** ... strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan....Join more than 7,000 associates and find a rewarding healthcare career at one of our 6 hospitals and… more
- Ascension Health (Kalamazoo, MI)
- … experience preferred. **Additional Preferences** There will be a dual focus on case management and utilization review in this position + Case Management ... **Details** + **Department:** Case Management + **Schedule:** Monday through Friday; Day shift...Michigan operates 16 hospitals and more than 300 related healthcare facilities that together employ nearly 23,000 compassionate associates.… more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordnation, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization of health care services with the goal...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordination, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization of health care services with the goal...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- Desert Parkway Behavioral Healthcare Hospital (Las Vegas, NV)
- …to ensure that all days are authorized and identify denied days, coordinate with Director of Utilization Review and add to Denial Tracker when appropriate. ... notes are documented, and the authorization detail is set up in Case Management . The information is subsequently verified in the payor websites where applicable.… more
- Molina Healthcare (CA)
- **JOB DESCRIPTION** **Job Summary** Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and ... authorization requests or for additional information as requested by the Medical Director . Must have: Medical terminology **ICD 10 code knowledge** **CPT code… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager- Utilization Management (UM) will be accountable for the management ... assess and make recommendations for improvements to maintain an effective and efficient utilization management process, as well as manage medical expenses based… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …bonus eligibility, and more! **Responsibilities** **JOB SUMMARY/PURPOSE** Provides leadership to Utilization Management RNs, Denials RNs and support staff to ... greater Puget Sound region. While you're busy impacting the healthcare industry, we'll take care of you with benefits...and regulatory requirements. This role would directly manage the Utilization Management staff as a centralized function… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical ... any time with or without notice. Primary Responsibilities * Perform prospective utilization reviews and first level determinations for members using evidenced based… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... Extended Care Facilities, Durable Medical Equipment vendors) in collaboration with Contract Management and Legal Affairs. + Assists Director in designing,… more
- Molina Healthcare (Madison, WI)
- …following key Healthcare Services functions: case management /disease management /care transitions; utilization management (Position oversees PA ... Active, unrestricted State Registered Nursing (RN) license in good standing. + Utilization Management Certification (CPHM) Certified Professional in Health Care… more
- Tenet Healthcare (Detroit, MI)
- Director of Case Management - 2406004325... utilization of resources Provides education to case management staff, physicians, and the healthcare team ... for case management scope of services including: Utilization Management supporting medical necessity and denial...delivery Ensures patient needs are communicated and that the healthcare team is mutually accountable to achieve the patient… more
- HCA Healthcare (Brentwood, TN)
- **Description** This position is incentive eligible. **Introduction** The Director Knowledge Management and Scholarly Communications for Graduate Medical ... and promoting the library's scholarly communications and education initiatives. The GME Director of Knowledge Management and Scholarly Communications will assist… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …third party payers and communicate potential or identified concerns to the treatment team, Director of Utilization Management , and the Medical Director . ... keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change....and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and… more
- Behavioral Center of Michigan (Warren, MI)
- …all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management . Reviews patient recrods and evaluates patient ... programs and advises physicians and other departments of regulations affecting utilization management . Consults with Social Services Department regarding the… more
- Katmai (Usaf Academy, CO)
- …**DESIRED QUALIFICATIONS &** **SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare ... precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical...Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current,… more
- Bassett Healthcare (Cooperstown, NY)
- …of risk management and patient safety initiatives within the Bassett Healthcare Network. The Director is responsible for identifying, planning, designing, ... the direction of the VP-Quality & Patient Experience, the Director of Patient Safety and Risk Management ...and the quality of services provided throughout the Bassett Healthcare Network. The Director develops processes to… more
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