- Humana (Montgomery, AL)
- …require interpretation and independent determination of the appropriate courses of action. The Post - Acute Utilization Management Nurse 2: + Review ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...required, with no disciplinary action + 2+ years of Post - Acute clinical experience in a SNF, LTACH… more
- Humana (Madison, WI)
- …and communication of medical services and/or benefit administration of post - acute determinations. The Manager, Utilization Management Nursing works ... community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills...Management experience is required for this role + Post - acute experience as it relates to skilled… more
- CVS Health (Atlanta, GA)
- …of residence + 1+ years of clinical experience in acute or post acute setting + Utilization management is a 24/7 operation. Work schedules will ... solutions to make health care more personal, convenient and affordable. **Position Summary** Utilization Management is a 24/7 operation and work schedule may… more
- CVS Health (Sacramento, CA)
- …- Must possess 1+ years of clinical experience in acute or post acute setting - Utilization management is a 24/7 operation. Work schedules will ... may include weekends and holidays and evening rotations._ As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate, document… more
- Sutter Health (Berkeley, CA)
- …change. This position coordinates the utilization management , resource management , discharge planning, post - acute care referrals and care ... interview patient/family and determine preferences for post - acute care services. Utilization Management . * Completes initial InterQual review screening… more
- Sutter Health (San Francisco, CA)
- …oversees the Case Management Assistants to determine preferences for post - acute care services. Utilization Management . * Reviews medical record to ... communicates to patient/family prior to transition. * Assures necessary paperwork for post - acute transfers to comply with state and federal regulatory… more
- CVS Health (Des Moines, IA)
- …Care experience + 1+ year(s) of clinical experience in acute or post - acute setting + Utilization management is a 24/7 operation. Work schedules may ... solutions to make health care more personal, convenient and affordable. Utilization management is a 24/7 operation. Work schedules may include weekends and… more
- Trinity Health (Des Moines, IA)
- …member of Mercy One's PHSO Care Management department, the Manager of Post Acute and Transition Care management provides leadership in understanding, ... management program. The incumbent is accountable for the management of all PHSO Post - Acute ...PHSO strategies and infrastructure necessary to effectively manage costs, utilization and quality associated with risk contracts in the… more
- HCA Healthcare (Asheville, NC)
- …prevent readmissions, and lower total cost of care thru the appropriate utilization of Post - Acute services.** **Qualifications:** **Required Education: ... environment where diversity and inclusion thrive? Submit your application for our Post Acute Transition Specialist CarePartners opening with CarePartners today… more
- Novant Health (NC)
- …PAC network tiering, leveraging data in payor relationships, benchmarking discharges to post - acute , increasing PAC network utilization , readmission reduction ... care. Reporting to the VP, Care Coordination and Post Acute , the Manager PAC Network will... care coordination in partnership with physician leaders, case management leaders and other administrative leadership across the system… more
- The Cigna Group (Bloomfield, CT)
- …medicine. + Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management Required Skills: Must be able to type 30 WPM, be ... Medical Director, Post - Acute Care Summary: The Medical Director...necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about… more
- Fresenius Medical Center (Lawrence, MA)
- …of the Fresenius' portfolio of products. + Work collaboratively with Senior Director of Post - Acute Commercial Operations team and Post - Acute National ... to ensure teamwork and proper allocation of nursing resources. + Work with Post - Acute National Account Manager(s) to improve and maintain center and patient… more
- The Cigna Group (Bloomfield, CT)
- …telephonic outreach, the Social Worker performs clinical and operational processes related to Post - Acute Care services, including but not limited to long-term ... skilled nursing, inpatient rehab, home health care, DME, care management , and utilization review. The social worker...acute care, a clinical setting, or in case management including experience/expertise in one of the following selected… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... ensure appropriate patient status and assists with repatriation and post -stabilization reviews for patients before the patient is bedded,...Degree in a health related field. + 3 Years Utilization Management or case management … more
- The Cigna Group (Nashville, TN)
- …of Provider Engagement Team with objective to build collaborative relationships with Post - Acute Care providers; drive performance through data analysis and ... clinical and medical economic solutions that lead to successful PAC management program implementations. Assists PAC and Evernorth Home Solutions Leadership to… more
- The Cigna Group (Nashville, TN)
- PAC Provider Engagement Advisor(PDP303) Builds relationships with Post - Acute Care/DME/Home Solutions providers; drives performance through data analysis and ... plan of action. Proactively identifies issues that may hinder provider relationships, utilization and financial performance and works with key individuals within the… more
- CVS Health (Tallahassee, FL)
- …to make health care more personal, convenient and affordable. **Position Summary** Utilization management is a 24/7 operation. Work schedules may include ... holidays and evening rotations. This is a full-time remote Utilization Management Nurse Consultant opportunity. As a...Registered Nurse + 1+ years of clinical experience in acute or post - acute setting +… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or ... direct communication with KSC Clinic Representatives as needed. The Utilization Management Representative is responsible for clerical...and entry of bed day data and pre and post - acute certification requests for specific services. Under… more
- CVS Health (Jefferson City, MO)
- …solutions to make health care more personal, convenient and affordable. **Position Summary:** Utilization Management is a 24/7 operation and work schedules may ... one major and one minor holiday yearly. As a Utilization Management Nurse Consultant, you will utilize...of residence + 1+ years of clinical experience in acute or post acute setting… more
- LA Care Health Plan (Los Angeles, CA)
- …clinical experience in an acute hospital setting. At least 2 years of Utilization Management /Case Management experience in a hospital or HMO setting . ... Utilization Management Nurse Specialist RN II...and Physician Advisor on case reviews for pre-service, concurrent, post -service and retrospective claims medical review. Monitors and oversees… more