- 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 (Phoenix, AZ)
- …care experience is in behavioral health) **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 + 1+ years' experience with Microsoft… more
- CVS Health (Austin, TX)
- …Suite (PowerPoint, Word, Excel, Outlook) 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 fully remote...Strong telephonic communication skills + Experience with computers toggling between… more
- VNS Health (Manhattan, NY)
- …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… 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
- 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
- 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 the 4 ... + A typical day would like in this role: Employee will be providing telephonic case management for our members. + Past job instability. Registered nurses MUST have… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- …Utilization Management services to its clients. Senior UM Coordinators facilitate utilization review by performing data collection, data entry, and ... concurrent reviews. The Senior UM Coordinator reports to the Manager, Utilization Management and/or Supervisor, UM Coordinators. Primary Responsibilities + Partner… more
- Elevance Health (Hermitage, PA)
- …**Manager II Behavioral Health Services** will be responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or ... assist with implementation of cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. + Hires, trains, coaches,… more
- Ventura County (Ventura, CA)
- …Duties may include but are not limited to the following: + Performs utilization review with pre-certification, concurrent, retrospective, out of network and ... experience in Case Management, Disease Management, Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and… 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
- CommonSpirit Health (Sacramento, CA)
- …community. **Responsibilities** **This is a remote position.** **Summary** The Utilization Management Physician Advisor II conducts clinical case reviews referred ... with the hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This position will be a part of the… more
- ManpowerGroup (Columbia, SC)
- …health, chronic or acute illnesses. **Key Responsibilities** + **Medical or Behavioral Review & Authorization Process (50%)** + Perform review and authorization ... within benefit and medical necessity guidelines. + Utilize resources to support review determinations. + Identify and make referrals to appropriate staff (eg,… 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
- Kepro (Oakland City, IN)
- …community. + Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other regulatory standards. ... coordination in defined areas of coal mine states and telephonic care coordination across the United States. An integrated...continue the plan of care and support transition. + Review the care plan and progress in regular care… 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 the 4 ... mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review /case management/clinical/or combination; 2 of the 4… more
- InnovaCare (San Juan, PR)
- …term. Assumes leadership across the continuum of care and promotes effective utilization of resources to obtain cost-effective outcomes. Coordinates care across care ... assessment. RESPONSIBILITIES 1. Reviews the High Risk-High Cost, Emergency Room Utilization and High Risks Assessment Reports, referrals from concurrent review… more
- ERP International (Scott AFB, IL)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... treatment team referrals. * Facilitates identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for… more
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