- 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 ... internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with...at Mount Sinai is ranked No. 14 nationwide in National Institutes of Health funding and in the 99th… more
- Trinity Health (Silver Spring, MD)
- …time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the Director, ... activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with...trusted provider of health services within our community. A Manager at Holy Cross Hospital is expected to demonstrate… more
- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- LifePoint Health (Danville, VA)
- *Registered Nurse, RN - Utilization Review Case Manager * Job Type:Full Time|Days *$10,000 Sign-on Bonus Eligibility for Full-Time, Bedside RNs* ** Must have ... in our community. Our hospital has a lower than national average patient ratio. Our team's approach to offering...in employment." **Job:** **Nursing* **Organization:** ** **Title:** *RN - Utilization Review Case Manager * **Location:**… more
- Covenant Health (Nashua, NH)
- …and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory ... health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. +… more
- Trinity Health (Mason City, IA)
- …**Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, ... in the state of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the state of Iowa preferred… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...Priority 5: Escalation Refers cases that require second level review to Physician Advisor, Manager , and Director… more
- UNC Health Care (Raleigh, NC)
- **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review for Surgical admissions** Become part of an inclusive ... care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management… more
- Trinity Health (Columbus, OH)
- …opportunities at the Mount Carmel College of Nursing **About the job:** The **RN Case Manager , Utilization Review ** ensures that services are delivered in a ... **Employment Type:** Part time **Shift:** **Description:** ** Utilization Review RN, Case Management** **Why...to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... Degree in Nursing; Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for Case Manager ...case management experience + 3 Years recent case management, utilization review , care coordination experience + California… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 **Job Brief** ... + Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS… more
- Elevance Health (Norfolk, VA)
- …PulsePoint locations. **Shift** : 4 weekdays and 1 weekend day as discussed with manager . The **Licensed Utilization Review II** is responsible for working ... **Title:** Licensed Utilization Review II **Location** : This...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Trinity Health (Maywood, IL)
- …at the Westmont office Join our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a ... make a lasting impact. Under the direction of the Director/ Manager oversees the daily caseloads of the UR/UM teams....the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral… more
- Elevance Health (FL)
- **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization ... with implementation of cost of care initiatives. + May attend meetings to review UM and discusses facility issues. + Hires, trains, coaches, counsels, and evaluates… more
- Trinity Health (Fort Lauderdale, FL)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization ... requirements of various commercial and government payers. On-Site Position** **_Position Purpose:_** Utilization Review (UR) Nurses play a vital role in… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- UNC Health Care (Hendersonville, NC)
- **Description** Job Summary The Utilization Manager (UM) assesses new admissions, continued stay and discharge review cases for medical necessity, ... in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities And Scope +...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge ... in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: * Uses approved...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Providence (Mission Hills, CA)
- **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... strong clinical background combined with well-developed knowledge and skills in Utilization Management, medical necessity, and patient status determination. The … more
- Commonwealth Care Alliance (Boston, MA)
- …services,procedures, and facilities under the provisions of CCA's benefits plan.The Manager , Utilization Management is responsible for overseeing and managing ... the daily operation of the Utilization Management Review Nurse and Specialist staff...in the area of service decisions and organizational determinations.The Manager , Utilization Management reports to the Director… more
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