- Community Health Plan of Washington (Eugene, OR)
- …an equitable work environment. About the Role The Level I Utilization Management Clinician performs utilization review for medical or behavioral health ... requests using utilization review criteria, technologies, and tools. Identifies, coordinates, and implements...or behavioral health setting. * Have previous experience in Utilization Management and Managed Care, preferred. Essential… more
- Pathways Vermont (Burlington, VT)
- …House Program Manager Supervisor: Alternative Mental Health Services Director Location: Burlington, Vermont Responsibilities:Oversight of Service ProvisionEnsure ... Practice Registered Nurse (APRN). Meet weekly for individual supervision, to review role expectations and provide feedbackProvide ongoing support for job completion… more
- Saint Francis Health System (Tulsa, OK)
- …an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care duties from an office location via secure virtual ... and support decision-making. Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Ability to receive… more
- Saint Francis Health System (Tulsa, OK)
- …Skills and Abilities: Working knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Effective interpersonal, ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- AdventHealth (Maitland, FL)
- …as assigned by the Division CFO/SrVP, Vice President of Revenue Cycle Operations and/or Director , Utilization Review Management ..Reviews data and trends ... review of long stay patients, in conjunction with the Director of Utilization Review Management to facilitate the use of the most appropriate level of… more
- St. Luke's University Health Network (Allentown, PA)
- …registrations and/or physician queries + Serves as liaison between Physician Advisor/Medical Director , Finance, Utilization Review Department and CDCI. ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- BrightSpring Health Services (Mishawaka, IN)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- WMCHealth (Valhalla, NY)
- … team clinical and nonclinical team activities to facilitate integrated proactive utilization management . Performs Case Management functions through ... Director , Clinical Care Mgmt Company: WMC...resource to other departments in developing greater awareness of utilization management MCG Clinical Care Guidelines. +… more
- CUNY (Hunter, NY)
- IT Academic Project Mgmt Director (IT Acd Tech Dir (HEO) - Instructional Computing & Information Technology (ICIT) **POSITION DETAILS** The ITAcademic Project ... Mgmt Director is primarily responsible for managing...systems and development initiatives through the application of project management tools and methodologies. The incumbent will work with… more
- YesCare Corp (Bartow, FL)
- …for ensuring the monthly report is sent to each site and participates in Utilization Review with Clinical Director and other personnel as required ... Below is a list of your responsibilities as a ** Utilization Management Coordinator** with YesCare: + Confirms...outpatient services, codes, and forwards to Corporate UM Medical Director + Performs monthly audit of Inpatient, ER and… more
- UCLA Health (Los Angeles, CA)
- Description Under the direction of the RN Asst. Director for Utilization Review , Intensive Case Management , you will support and perform duties to ... provide discharge planning/ UM concurrent review of the complex cases admitted in Non Domestic...BSN Degree + Minimum of 2 years' experience in utilization management , Inpatient CM or clinical Experience… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... of members. We are looking for an experienced Medical Director in the greater Baltimore / Washington DC metropolitan...post-acute care, and appeals. + Oversees all activities of utilization review , care management and… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... processes appeals and reconsiderations. In collaboration with the Division Director Care Coordination, the UM Director develops...medical staff on issues related to utilization management . 1. Implements utilization review … more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position...patients not meeting inpatient criteria. C. Participates in local Utilization Review Committee and be a member… more
- Arms Acres (Bronx, NY)
- …life skills) as identified in patient treatment plans and requested by program director . Performs utilization review , provides progress reports and develop ... drugs. Sign-on bonus eligible FUNCTION: To provide comprehensive clinical case management services that include: assessments; individual, group and family treatment;… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Corporate Director of Clinical ... Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according to… more
- Molina Healthcare (CA)
- … Director of Healthcare Services position will be overseeing the Outpatient Utilization Management Team. Candidates must have an active California Nursing ... of the following key Healthcare Services functions: case management /disease management /care transitions; utilization management (Position oversees PA… more
- Geisinger (Harrisburg, PA)
- …and provide effective and meaningful educational programs across the department. Responsible for management of the Utilization Review policy and observation ... Establishes and leads execution of a strategic plan for the provision of Utilization Management services across the organization, fostering a spirit of… more
- Ascension Health (Baltimore, MD)
- …leadership and Sr Dir of CM as appropriate * Performs other duties as assigned Utilization Management : + Ensures integration of utilization management ... initiatives. + Develops systems and processes for prospective, concurrent and retrospective utilization review for all self-funded and fully insured clients to… more
- Beth Israel Lahey Health (Burlington, MA)
- …necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested ... Decision-Making Authority: Responsible for collaborating with the utilization review department as these issues relate to commercial payers, to meet established… more
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