- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... your internet provider (non-satellite). + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a rotating ... the clinical and financial plan for patients. Performs overall utilization management, resource management, discharge planning and post-acute care referrals… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... the TN market. Must be located within TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal role,… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical ... regulatory standards, and enhancing the overall utilization review process to optimize patient care...management program, denials and appeals activities. Works with UR Director , UR Senior Director , and Payor Relations… more
- Katmai (Usaf Academy, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… more
- UTMB Health (Webster, TX)
- Utilization Review Case Mgr- CMC-Clear Lake...measures to achieve target. + Presents LOS variances for review to Director and Inpatient Medical ... observation in Community Hospitals and UTMB-TDCJ Hospital. + Performs utilization review procedures by prospectively, concurrently, and...transfers and admissions from the prison facility. + Conducts nurse to nurse conference calls for all… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... medical necessity guidelines. Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director… 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
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... functions for assigned sites. + Collaborate with the director to develop and implement quality review ...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Community Health Systems (Franklin, TN)
- …nursing experiencePreferred Experience: 3 plus years Utilization review experience + Required License/Registration/Certification: Licensed Practical Nurse ... of medical services and procedures in the hospital setting. Utilization review is the assessment for medical...part of the application or hiring process, contact the director of Human Resources at the facility to which… 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. + ... Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships,… more
- RWJBarnabas Health (Newark, NJ)
- Registered Nurse (RN) Director of Patient Care Cardiac Cath Lab FT DaysReq #:0000180082 Category:Leadership Status:Full-Time Shift:Day Facility:Newark Beth ... Job Overview: RWJBarnabas Health is seeking a highly dedicated Director of Nursing for our Cardiac Cath Lab at...American Heart Association (AHA) + Active New Jersey Registered Nurse License or Multistate Compact License Scheduling Requirements: +… more
- RWJBarnabas Health (Livingston, NJ)
- …Management Department, including but not limited to clinical resource management, utilization review , discharge planning, patient advocacy, oversight of nursing ... Director (Registered Nurse ), Case Management (Full-Time/Days)Req...Department, including but not limited to clinical resource management, utilization review , discharge planning, patient advocacy, oversight… more
- ERP International (Nellis AFB, NV)
- …the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- Banner Health (Mesa, AZ)
- …no better time than now to be a part of our team. As the **Associate Director of NICU** you will be leading a high-quality team with expertise in Neonatal Intensive ... drives high clinical outcomes, excellent experience, and effective resource utilization . The role actively participates in department and facility...operations of the unit and reports to the WIS Director of Nursing. As a member of our team,… more
- BrightSpring Health Services (Dunbar, WV)
- …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
- CenterLight Health System (NY)
- …a good understanding of managed care tactics, quality management, HEDIS, peer review , and utilization management (UM). + Interest in building connections ... responsibility for the management of internal providers. Collaborates with the Medical Director / Chief Medical Officer on managing the relationships with the… more
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