- 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 weekend and holiday schedule.** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall … more
- 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 ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Stanford Health Care (Palo Alto, CA)
- …work-life balance while honoring its commitment to delivering evidence-based and patient-centered care . We are seeking a results-driven manager to further ... our robust, Utilization Management team. Are you driven by health care innovation, partnerships, and measurable results to improve the continuity of care… more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Nurse Manager (NM) is a registered professional nurse responsible for the assessment, planning, provision and ... as it relates to the practice of utilization management. Responsibilities The Utilization Management (UM) Nurse Manager (NM) s directly supervised by the… more
- Sutter Health (Sacramento, CA)
- … care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides third-party payers clinical information ... SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that the right … more
- VNS Health (Manhattan, NY)
- … utilization management processes are followed by the service operations staff, utilization staff, and the interdisciplinary care team to ensure cost ... , staff productivity and coverage. + Generates management reports via the care / utilization management systems and demonstrates competency as a super user… more
- Centene Corporation (Tallahassee, FL)
- …nursing, personal care services / home health, pediatric direct care , healthcare operational leadership, and utilization management. **Position Purpose:** ... Concurrent Review, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to… more
- Mount Sinai Health System (New York, NY)
- …in Nursing or health-related field preferred. + 5 years minimum of progressive acute care leadership and acute care utilization review experience. + ... **Job Description** The Utilization Review Manager for the Selikoff...area of nursing practice assigned; in this case, acute care utilization review. + Previous experience making… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management, ... containment activities, and services on automated UM review. The Program Manager will ensure accurate implementation, system configuration and appropriate benefit… more
- Prime Healthcare (Elgin, IL)
- …required professional . 2. Minimum of 3 years' experience in Utilization review / Denial management process. Preferred qualifications: 1. ECFMG Certification ... staff and hospital management staff. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/179182/regional- utilization -review- manager /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySaint Joseph Hospital - Elgin… more
- VNS Health (Manhattan, NY)
- …and cost-effective health care services. Manages providers, members, team, or care manager generated requests for medical services and renders clinical ... subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure … more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... current with industry standards and business objectives related to Utilization and Care Management as appropriate. |...minimal oversight and direction. | Demonstrates a courteous and professional demeanor, team spirit and the ability to work… more
- Mayo Clinic (Jacksonville, FL)
- …by ensuring appropriate utilization management, care coordination, resource utilization , and clinical documentation. The RN Case Manager will function ... includes accountability for assessing, planning, implementing, evaluating, and communicating the patient care plan progression. The RN Case Manager utilizes the… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** On-site, Monday-Friday, 8:00AM-4:30PM. Must be available as needed to address urgent or ... and comparison with associates in similar roles_ **Registered Nurse, Certified Case Manager (CCM, ACM, URAC) preferred or willing to obtain within 1 year.**… more
- Hackensack Meridian Health (Neptune, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The ** Care Coordinator, Utilization Management** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Holmdel, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The ** Care Coordinator, Utilization Management** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …expertise. Guiding, developing, and supporting staff from a leadership perspective. Using professional standards of care scientific evidence, and practice to ... outcomes for discharge. Advocates for fiscal responsibility in the management of care through effective utilization of resources. Provides education to rotating… more
- LA Care Health Plan (Los Angeles, CA)
- …Preferred: Knowledge of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department ... Utilization Management Nurse Specialist RN II Job Category:...$115,509.00 (Mid.) - $142,166.00 (Max.) Established in 1997, LA Care Health Plan is an independent public agency created… more
- Morris Hospital (Morris, IL)
- …achieved within established time frames for assigned patients. Coordinates the plan of care with the physicians, nurses and other health care professionals from ... evidenced-based clinical guidelines. Performs duties in accordance with the Utilization Review Plan. Demonstrates thorough knowledge of performance measure… more
- ERP International (Nellis AFB, NV)
- …regional offices, Manage Care Support Team, MTF staff and professional organizations concerning Utilization Management practices. * Collaborates with ... to patients, families/ care givers, medical and non-medical staff in a professional and courteous way. * Communication. Demonstrate ability to utilize verbal and… more