- Trinity Health (Silver Spring, MD)
- …/supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related ... RN with BSN or RN with > 10 years case management experience. Masters Degree preferred. **Minimum...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …medical necessity criteria and BCBSMA policies and procedures + Focus on efficient utilization management with emphasis on discharge planning + Understand and ... and/or share information relating to benefits and the BCBSMA utilization management process + Collaborate with members/families,...Identify and refer members who may benefit from high-risk case management and disease state management… more
- Fairview Health Services (St. Paul, MN)
- …in the role (grandfather status) + Current RN licensure in MN + 3-5 years utilization review or case management experience in hospital, clinic, insurance ... M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This position provides...on call, as assigned. + Must be willing to travel to other Fariview sites as needed. **Other Skills… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review, billing, or coding experience ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, mandates,… more
- Humana (Salem, OR)
- …analytical reports to monitor and track operational efficiency + Ability to perform case reviews. Properly documents utilization management activities and ... community and help us put health first** The Manager, Utilization Management Nursing utilizes clinical nursing skills...business need, leaders rotate weekend coverage) + 10%-15% of travel may be required in the future based on… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... (BSN) degree required + Five or more years of utilization management required + Four or more...complex federal and private insurance regulations + Ability to travel /attend off-site meetings and conferences + ACM - Accredited… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- Utilization Review Nurse Coordinator (40 Hour) Office/On-site Recruitment # 241106-5613FP-001 Location East Hartford, CT Date Opened 11/7/2024 12:00:00 AM Salary ... - is accepting applications for a full-time Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) position, located… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... to Manager appropriate information including, but not limited to, customer/ case issues, reports, trends/variances, action plans, etc. **SUPERVISORY RESPONSIBILITY:**… more
- CVS Health (Springfield, IL)
- …and affordable. **Position Summary:** The Associate Manager is responsible for oversight of Utilization Management / Case Management staff. This position ... years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership...1+ year Leadership experience (formal or informal roles) + Travel Required up to 5% for meetings/audits + 1+… more
- State of Connecticut, Department of Administrative Services (Middletown, CT)
- … review and/or quality assurance programs; + Conducts various types of case reviews for quality and appropriate medical management , cost containment, ... Utilization Review Nurse (40 Hour) Office/On-site Recruitment #...+ Incumbents in this class may be required to travel . Conclusion AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER The State… more
- Ascension Health (Milwaukee, WI)
- …for additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization ... **Details** + **Department:** Utilization Management + **Schedule:** Day Shift,...medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases.… more
- Ascension Health (Manhattan, KS)
- …for additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization ... **Details** + **Department:** Utilization Management + **Schedule:** Full Time,...medical necessity and/or compliance with reimbursement policy criteria. Provide case + management and/or consultation for complex… more
- Ascension Health (Nashville, TN)
- …for additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization ... **Details** + **Department:** Case Management + **Schedule:** Full-Time, Monday-Friday...coordinate compliance to federally mandated and third party payer utilization management rules and regulations. **Requirements** Licensure… more
- Ascension Health (Austin, TX)
- …for additional specifics._ **Responsibilities** Provide health care services regarding admissions, case management , discharge planning and utilization ... and retrospective medical necessity and/or compliance with reimbursement policy criteria. Provide case management and/or consultation for complex cases. + Assist… 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 ... work independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience… more
- Houston Methodist (Baytown, TX)
- …(MSW) + Master's in nursing preferred **WORK EXPERIENCE** + Five years experience in inpatient case management , social work or utilization management or ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
- Houston Methodist (The Woodlands, TX)
- …Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work department. This position is an integrated, ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
- ERP International (Nellis AFB, NV)
- …of care; and utilization of resources. Monitors and evaluates the facility's case management program per DoD, AF, DHA and local policies and guidelines. ... * Travel outside of the local MTF and/or off the...last 24 months o Experience in case management , condition management , discharge planning, utilization… more
- Health First (Viera, FL)
- …in a acute care hospital. * Knowledge/Skills/Abilities: o Knowledge of care transitions, utilization management , case management , performance improvement ... 3. Practices autonomously, consistent with evidence-based standards. 4. Serves as a case management resource expert for compliance with Medicare IM letter,… more
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