- UPMC (Mechanicsburg, PA)
- **UPMC is hiring a Sr . Professional Care Manager for UPMC West Shore! This is a full time, day shift position and requires a rotating weekend and holiday schedule.** ... **Purpose:** The Senior Care Manager (CM) coordinates the clinical and financial...the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care… more
- Dignity Health (Stockton, CA)
- …and other medical centers and agencies who serve as referral sources including utilization review and managed care companies. This position requires providing ... excellent care. St. Josephs Behavioral Health Center is a licensed not-for-profit facility providing comprehensive behavioral health services for psychiatric… more
- CVS Health (Columbus, OH)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management, reimbursement methods and treatment protocols for DSNP/MMP and other ... Health, Pharmacy, member outreach, Care Management, National Quality Management, Utilization Management, Compliance, and other departments to integrate social,… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Senior Staff Pharmacist position is responsible for an expanded clinical role that may include responsibility for proactive review of ... areas of the department to include processing orders, therapy review , and education to patients and other members of...the direct patient care team. Other duties for the Senior Staff Pharmacist position include serving as a role… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Senior Exercise Physiologist position effectively evaluates patients referred to the Cardiac Rehabilitation program, develops and ... Department and Houston Methodist. This program operates very independently and the Senior Exercise Physiologist position conducts the day to day operations of the… more
- Ascension Health (Wamego, KS)
- …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
- MyFlorida (Land O' Lakes, FL)
- SENIOR LICENSED PRACTICAL NURSE - 50000082 Date: Dec 30, 2024 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 843801 Agency: Veterans Affairs Working Title: SENIOR LICENSED PRACTICAL NURSE - 50000082 Pay Plan:… more
- HCA Healthcare (Kansas City, MO)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... assistance (tuition, student loan, certification support, dependent scholarships) + Colleague recognition program + Time Away From Work Program (paid time off,… more
- HCA Healthcare (Dallas, TX)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... colleagues invested over 156,000 hours volunteering in our communities. As a(an) Licensed Inpatient Therapist with Medical City Green Oaks Hospital you can be… more
- HCA Healthcare (Fort Walton Beach, FL)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... purpose and integrity. We care like family! Jump-start your career as a(an) Licensed Mental Health Professional II Masters today with HCA Florida Fort Walton-Destin… more
- HCA Healthcare (Richmond, VA)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... our Licensed Clinical Therapist Social Worker opening. We promptly review all applications. Highly qualified candidates will be contacted for interviews.… more
- HCA Healthcare (Falls Church, VA)
- …guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality ... you find this opportunity compelling, we encourage you to apply for our Licensed Inpatient Therapist opening. We promptly review all applications. Highly… more
- Magellan Health Services (San Diego, CA)
- This position is remote in California, candidates must be licensed and reside in CA. Part Time position. This position supports the clinical vision for the health ... appropriate for complex case management and timely completion of all utilization management activities. Involvement in the development of case management plans.… more
- Penn Medicine (Eatontown, NJ)
- …Effective and timely completion of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and ... group treatment, treatment plan implementation and coordination, discharge planning, utilization management with insurance companies, and case management with social… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: The Utilization Review /Quality Assurance Sr . Coordinator will be responsible for providing clinical information to managed care companies as ... agencies, and other health care related entities. Preferred Qualifications: Utilization Review /Managed Care/Quality Assurance experience. Experience in the… more
- Prime Therapeutics (Columbus, OH)
- … functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... depth perception and ability to adjust focus **Reporting Structure** + Reports to Sr Professional, Manager, Director or Senior Director in the Compliance… more
- VNS Health (Bronx, NY)
- …Participates and consults with team supervisor in case conferences, staff meetings, utilization review and discharge planning meetings to determine if ... symptoms to help them remain safely in the community This is a senior , master's level, licensed social services role that provides direct care as part of a team.… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care. + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs. + At ... Center. Ventura County Health Care Plan (VCHCP), a fully licensed Plan, was established in 1993 as a practical,...care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review … more
- Magellan Health Services (Albuquerque, NM)
- …to an assigned interdisciplinary UM team. + Responsible for the quality of utilization review determinations, including appeals. + Reviews cases, makes medical ... is remote in New Mexico, candidates must be NM licensed and reside in NM. This position supports the...effectiveness and cost of care of clinical programs through review and analysis of utilization and financial… more
- City and County of San Francisco (San Francisco, CA)
- …permanent 2932 positions + All City departments with open permanent positions can review your application Under direction, the 2932 Senior Behavioral Health ... Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health...the California Board of Behavioral Sciences (BBS) for + Licensed Clinical Social Worker (LCSW) OR + Licensed… more