- CHRISTUS Health (Lake Charles, LA)
- …Supervisor experience overseeing work of assigned units, preferred. Previous healthcare management experience preferred. Licenses, Registrations, or ... high-quality, cost-effective care to patients. Responsible in assisting the Director for analyzing, planning, implementing, evaluating, and communicating processes… more
- 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
- Commonwealth Care Alliance (Boston, MA)
- **Why This Role is Important to Us:** The Director of Utilization Management leads and manages all utilization management (UM) functions for physical ... state and federal regulatory requirements and all applicable accreditation standards. The Director of Utilization Management is responsible for setting… more
- Dignity Health (Bakersfield, CA)
- …Nevada or Arizona, with a clear and current CA RN license.** **Position Summary:** The Director of Utilization Management is the senior lead over the ... Director is also responsible for the oversight of utilization management auditing, both internal and external,...(RN) license. - Knowledge of federal, state and local healthcare related laws and regulations; ability to comply with… more
- Dignity Health (Bakersfield, CA)
- …capitation, HMO regulations, managed healthcare systems, quality improvement, medical utilization management , risk management , risk adjustment, disease ... work within PST business hours.** **Position Summary:** The Medical Director of UM reports to the Chief Physician Executive...Minimum of 10 years+ of clinical experience in a Utilization Management setting preferred - Board Certified… more
- Fallon Health (Worcester, MA)
- …MA (or licensable). Board certified in medical or surgical specialty. **Experience:** Utilization management ; network management ; medical policy and ... This position works with both inpatient and outpatient Care Management nurses to monitor appropriate care and services in...review + Pharmacy issues and referral requests + Medical director on-call coverage + Support the benefits and technology… more
- HCA Healthcare (Campbell, CA)
- …integrity. We care like family! Jump-start your career as a(an) Utilization Management RN today with HCA Healthcare . **Benefits** HCA Healthcare , offers ... Are you passionate about the patient experience? At HCA Healthcare , we are committed to caring for patients with...vary by location._** Come join our team as a(an) Utilization Management RN. We care for our… more
- Hartford HealthCare (Torrington, CT)
- …Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry Patient ... Social Work * Active LCSW required * Two years with behavioral health utilization review As a Hartford HealthCare entity, Charlotte Hungerford Hospital provides… 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
- Huron Consulting Group (Chicago, IL)
- …patients, and insurance companies to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures ... Utilization Management Specialist is responsible for ensuring the appropriate utilization of healthcare services by reviewing patient cases for medical… more
- Trinity Health (Silver Spring, MD)
- …healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... + Full-Time 8am - 4:30pm + Reporting to the Director of Care Management + The RN...clinical of Nursing experience in an acute healthcare setting. + Designation Changes and Utilization … more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Director of Clinical Case Management ? At HCA Healthcare , you come first. HCA Healthcare has committed up ... members over the course of three years. **Benefits** HCA Healthcare , offers a total rewards package that supports the...make a difference. We are looking for a dedicated Director of Clinical Case Management like you… more
- Elevance Health (Topeka, KS)
- …week. This is a hybrid role.** The **Manager of Behavioral Health - Kansas - Utilization Management (BH UM)** will manage a team of licensed clinicians and ... facility-based and/or outpatient psychiatric and chemical dependency treatment and prior utilization management experience; or any combination of education and… 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
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure Insurance and Utilization Management Maintains working knowledge of CMS requirements and ... Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review/ Management RN. This position is to conduct initial, concurrent,… 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
- 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
- Guthrie (Binghamton, NY)
- LPN - Utilization Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer, in collaboration with other internal and ... payors, and providers and staff, is responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification… more
- HCA Healthcare (Bountiful, UT)
- …charitable organizations. Apply Today! **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and ... We care like family! Jump-start your career as a(an) Director Case Management today with Lakeview Hospital....to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
- HCA Healthcare (Englewood, CO)
- …goals. Unlock your potential! **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and ... over 156,000 hours volunteering in our communities. As a Director Case Management with Swedish Medical Center...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
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