- Sanford Health (MN)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- BayCare Health System (Clearwater, FL)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... the Tampa Bay area. Our network consists of 16 community- based hospitals, a long-term acute care facility, home...compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +… more
- Ascension Health (Milwaukee, WI)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee...home health services. Ascension is a leading non-profit, faith- based national health system made up of over 134,000… more
- Centene Corporation (Madison, WI)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE/WORK FROM HOME , WORK SCHEDULE WILL BE MONDAY-FRIDAY 8AM - 5PM DURING TRAINING, WITH… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- HCA Healthcare (Ogden, UT)
- …Apply Today! **Job Summary and Qualifications** The Mental Health Professional/ Utilization Review role primarily involves reviewing medical records ... guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality… more
- CareFirst (Baltimore, MD)
- …detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services. ... expected to work a portion of their week from home and a portion of their week at a...Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience.… more
- VNS Health (Manhattan, NY)
- …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... by assigned staff or through contract relationships in both home and community- based settings. * Manages and...Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with… more
- LA Care Health Plan (Los Angeles, CA)
- …providing clinical review and authorization for alternate levels of care, home health, durable medical equipment, and other discharge needs. Provides support to ... Utilization Management Admissions Liaison RN II (After Hours...in real-time and post admission to issue a determination based on clinical criteria for medical necessity. Assures timely,… more
- Humana (Salem, OR)
- …our caring community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills to support the coordination, ... of medical services and/or benefit administration determinations. The Manager, Utilization Management Nursing works within specific guidelines and procedures;… more
- Humana (Boise, ID)
- …and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
- Sanford Health (Fargo, ND)
- …while managing the cost of care. Promotes patient wellness through evidenced based practice, improved care outcomes, efficient utilization of health services, ... continuum for assigned patient populations. This position primarily focuses on Utilization Management activities such as: * Evaluate medical necessity, efficiency… more
- Sharp HealthCare (San Diego, CA)
- …necessity reviews and authorizes medical services that meet medical criteria. The review of care is region specific and consists of outpatient healthcare services ... pre-certification requests, outpatient procedures, outpatient services, elective inpatient admissions, home health services, genetic testing, orthotics, prosthetics and complex… more
- Motion Recruitment Partners (Durham, NC)
- Utilization Management Specialist Durham, NC **100% Remote** Contract $17/hr - $17/hr Our client, a nationally recognized and award-winning company in the health ... insurance vertical, has a contract opening for a Utilization Management Specialist. They have over 4 million customers...**Location:** ** While the position is Remote, work from home , you must reside in North Carolina or one… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination...expected to work a portion of their week from home and a portion of their week at a… more
- Carle (Urbana, IL)
- Utilization Manager - Adolescent Psych Young Minds +...of admission and at least twice a week to review patient's progress, in order to report to payors ... None Email a Friend Save Save Apply Now Position Summary: To provide utilization management services to the inpatient unit facilitating the delivery of appropriate,… more
- BAYADA Home Health Care (Pennsauken, NJ)
- BAYADA Home Health Care is in search of a Regional Client Services Manager ll to support both the Bonsai and American Elm Regions. This role will encompass all ... the CSM seat when required. Qualifications **Minimum of two (2) years of BAYADA Home Health Care client services manager experience, within the Home Health… more
- Veterans Affairs, Veterans Health Administration (Rock Hill, SC)
- …Columbia VAMC is hiring a Kinesiotherapist! This position is located within the Home Based Primary Care (HBPC) Program within GEC. The Rehabilitation Therapist ... to, any of the following: pre- habilitation, acute, sub-acute, transitional, home - based , post rehabilitative, and wellness programs. Administer musculoskeletal,… more
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