- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... Must be available during weekday hours. 8a-5p *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement,… more
- Community Health Systems (Franklin, TN)
- …necessity, discharge planning, and payer requirements. Documents all utilization review activities in the hospital's case management software, including ... required Bachelor's Degree in Nursing preferred 2-4 years of clinical experience in utilization review , case management , or acute care nursing required… more
- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care....in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and… more
- AmeriHealth Caritas (Newtown Square, PA)
- Role Overview The Utilization Management Review Supervisor manages a remote team of clinical reviewers who process prior authorization requests for Community ... Provide daily oversight, support, and direction to a remote team of Utilization Management Reviewers Clinical and technical support: Offer guidance on… more
- Kaiser Permanente (Olympia, WA)
- …team members. Preferred Qualifications Minimum two (2) years of RN experience in utilization review , ambulatory case management , care coordination or disease ... management . Education Bachelors degree License, Certification, Registration Registered Nurse License (Washington) required at hire OR Compact License: Registered… more
- University Health (Pleasanton, TX)
- …(as a Staff nurse II or above). Work experience in case management , utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS ... Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must… more
- University Health (Pleasanton, TX)
- …(as a Staff nurse II or above). Work experience in case management , utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS ... Nurse with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must… more
- Christus Health (San Antonio, TX)
- …Medicare GMLOS by managing per Milliman/Interqual Care Guidelines. Resource/ Utilization Management /appropriateness: Assess assigned patient population for ... This position provides expertise and leadership to insure effective resource management for patient care delivery (Conditions of Participation COP 482.30). Case… more
- Mount Sinai Health System (New York, NY)
- …to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using standardized ... Job Description RN/Case Manager MSH Case Management FT Days The Case Manager (CM) will...Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case… more
- Community Health Systems (Naples, FL)
- …Management is responsible for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and ... delivered efficiently, effectively, and in compliance with organizational standards. Oversees utilization review and discharge planning processes to ensure… more
- UnitedHealth Group (Hartford, CT)
- …Preferred Qualifications: Registered Nurse 2+ years of experience in Utilization Management Experience working with federal contracts CES (Claims Editing ... and cost avoidance development Serves cross-functionally with Medical Directors, and sometimes Utilization Management , as well as other internal teams to assist… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... clinical nursing/patient care experience which includes three years in utilization review , case management or...preferred LICENSES AND CERTIFICATIONS - REQUIRED RN - Registered Nurse - Texas State Licensure -- Compact Licensure -… more
- Kaiser Permanente (Vallejo, CA)
- …the standards for corrective action plan for improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... quality improvement evaluations, special projects, and other work for multidisciplinary review ; defining the standards for integrating multiple utilization data… more
- Kaiser Permanente (Pleasanton, CA)
- …by: researching corrective action plan for areas of improvement identified through utilization review , clinical records audit, claim denials, member satisfaction ... stakeholders to develop resolutions. Develops stakeholder development and quality performance review processes by: developing and improving the utilization and… more
- UnitedHealth Group (Omaha, NE)
- …oversight meetings with the outward facing Chief Medical Officers, network contractors, nurse management and other internal managers Maintain proficiency in all ... Growing together. We are currently seeking an Inpatient Care Management Medical Director to join our Optum team. This...of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level.… more
- Sharp HealthCare (San Diego, CA)
- …of the manager of in-patient care management and the Director of Utilization Management . Required Qualifications 3 Years Experience in the acute patient care ... Facility/Regional - SCMG Operations meetings and task forces.Facilitate regional Utilization Management committees and other working regional… more
- Ascension Health (Pensacola, FL)
- …two (2) years of proven leadership or management experience, preferably overseeing Case Management or Utilization Review teams in an Acute Care setting. ... Details Department: Case Management Schedule: Full time Day Shift Hospital: Ascension... department. Requirements Licensure / Certification / Registration: Registered Nurse credentialed from the Florida Board of Nursing obtained… more
- Kaiser Permanente (San Francisco, CA)
- …Partnership environment. Preferred Qualifications: Minimum two (2) years of experience in utilization review , case management , and discharge planning ... for alternative levels of care as required. Essential Responsibilities Utilization Management : Performs daily pre-admission, admission, and concurrent… more
- University Health (Boerne, TX)
- …Three years recent, full time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- Novo Nordisk Inc. (Los Angeles, CA)
- …include key opinion leaders (KOL's), academic institutions, physicians, nurse practitioners, diabetes educators, pharmacists, blood bank staff, organized ... policies, legal, regulatory, and compliance requirements Ensures effective administrative management of regional business as well as operational budgets Maintains… more
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