- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Sharp HealthCare (San Diego, CA)
- …and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as specified ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Centene Corporation (Madison, WI)
- …5+ years of related experience. 2+ years supervisory experience preferred. Knowledge of utilization management principles preferred. ... Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and… more
- Trinity Health (Silver Spring, MD)
- …closely related area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of pertinent regulatory, ... **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision...with BSN or RN with > 10 years case management experience. Masters Degree preferred. **Minimum Knowledge ,… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... + Thorough knowledge of health care industry, utilization review, utilization management , and...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Hospital at...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management , utilization review, social work, care coordination and discharge planning. + ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Guidelines (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) -… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Amazon (Herndon, VA)
- …achieve in the cloud. Basic Qualifications - 3+ years of technical infrastructure management experience - Knowledge of best practices and emerging technologies, ... them to completion. We're seeking an experienced Technical Infrastructure Program Manager to oversee data center electrical infrastructure optimization projects. You… more
- Sharp HealthCare (San Diego, CA)
- …Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American ... (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association...Advanced clinical skills in area of expertise. + Proficient knowledge and understanding of utilization management… more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... disciplines to include discharge planning and referrals for case management . * Utilization management duties...due to need for extended care services. * Mandatory knowledge and skills: * Must have knowledge … more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/180750/case- manager -rn utilization - management ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS (AHA) certificate, preferred.5. Knowledge of Milliman… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/181372/case- manager -%28rn%29 utilization - management ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS (AHA) certificate, preferred.5. Knowledge of Milliman… more
- Healthfirst (NY)
- … management , identifying alternative care options, and discharge planning + Certified Case Manager + Milliman knowledge + Knowledge of Centers for ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes:...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Trinity Health (Mason City, IA)
- …nurse in the state of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the state of Iowa ... Type:** Part time **Shift:** Day Shift **Description:** **Position Purpose:** The Utilization Review Case Manager responsibilities include case screening,… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Hackensack Meridian Health (Holmdel, NJ)
- …transform healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management ** is a member of the healthcare team and is ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- Acacia Network (Bronx, NY)
- Acacia Network Inc. Utilization Manager Bronx, : 5/30/2024 Job Description Job ID#: 3904 Job Category: Acacia Network Inc. Position Type: Full Time Details: ... strict confidentiality and compliance with HIPPAA. + Maintains full knowledge and understanding of state and federal regulations as...Degree preferred) + Minimum of 2 years of case management and/or utilization review experience + Strong… more
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