- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager II** is responsible for care management within the scope… more
- UPMC (Pittsburgh, PA)
- …County Care Management Team. The team is looking to hire either an RN (as a Telephonic Care Manager) or a social worker (as a Health Care Manager). The team is based ... implemented. + Utilizes supervision by identifying and reporting to supervisor clinical, utilization and outcomes issues. + Preserve confidentiality of the member. +… more
- ICW Group (Woodland Hills, CA)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate...Providers. + May perform Utilization Review activities (or review … 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 ... and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would like in this… more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
- CVS Health (Harrisburg, PA)
- …needs + Holiday rotation required **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... convenient and affordable. Requisition Job Description **Position Summary:** **This Utilization Management (UM) Nurse Consultant role is 100% remote...Strong telephonic communication skills + Time efficient and highly organized… more
- CVS Health (Albany, NY)
- …9pm EST depending on business needs **Preferred Qualifications** - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote...Strong telephonic communication skills - Time efficient and highly organized… more
- CVS Health (Tallahassee, FL)
- …+ Must live in Eastern time zone **Preferred Qualifications:** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + Strong ... care more personal, convenient and affordable. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote...telephonic communication skills + 1+ years' experience with Microsoft… more
- Spokane County (Spokane, WA)
- …Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - ... and discharges or lack of movement toward discharge. + Collaborates with Utilization Review Integrated Care Coordinator regarding continued inpatient stay… more
- CommonSpirit Health (Phoenix, AZ)
- …of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. 4. Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... inside our hospitals and out in the community. **Responsibilities** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews… more
- The Cigna Group (Baltimore, MD)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
- The Cigna Group (Houston, TX)
- …works as part of the team to manage heath care cost and utilization **Provider Support** 1. Completes telephonic nursing assessments including social ... and make specific recommendations based on their goals 4. Review paperwork for patients to ensure it meets all...to nursing team by clinical support staff. 2. Provide telephonic nursing assessment and triage supported by triage protocols.… more
- CVS Health (Santa Fe, NM)
- …English **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... discharge planning experience preferred + Discharge planning experience + Utilization review , prior authorization, concurrent review , appeals experience +… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
- Highmark Health (Columbus, OH)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- AON (TX)
- …quality and timely delivery. + Meet or exceed assigned billable hours and utilization goals. + Communicate and collaborate with manager and Account Executives to ... relating to services rendered by carriers and/or TPAs to include the review and revision of account instructions, addressing client service concerns and negotiating… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Fallon Health (Worcester, MA)
- …represent Fallon Health in a positive way. SWCM seeks to establish telephonic and/or face to face relationships with the member/caregiver(s) to better ensure ... rounds and huddles o Works with members of the Utilization Management Department assisting with difficult or complex care...providers and office staff and may lead care plan review with providers and care team as applicable o… more
- CommonSpirit Health (Englewood, CO)
- …both inside our hospitals and out in the community. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred ... hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management… more
- Spectrum Health Services (Philadelphia, PA)
- …health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate ... team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential… more
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