- Novo Nordisk Inc. (Plainsboro, NJ)
- …to make a difference? The Position Drive portfolio strategy and study management activities and manage cross-functional study team, external service providers (CROs, ... and retention strategies to deliver enrollment targets. Accountable for overall performance management of trial managers and CSLs, who contribute to the planning,… 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
- 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
- Humana (Lexington, KY)
- …help us put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Nurse 2 who will utilize clinical nursing skills to support ... services and/or benefit administration determinations for Humana's Kentucky Medicaid Plan. The Utilization Management Nurse 2 work assignments are varied and… 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
- CVS Health (Lansing, MI)
- …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...experience (formal or informal roles) with direct reports + Travel Required up to 5% for meetings/audits + Must… 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
- UTMB Health (Friendswood, TX)
- …ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/ Case Management program by utilizing clinical ... + Supervises the operational management of the Utilization Review/ Case Management program to...Standard office equipment. **_WORK ENVIRONMENT_** **:** + May involve travel . + May involve occasional shift work and weekends… more
- State of Connecticut, Department of Administrative Services (Hartford, 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
- 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
- Guthrie (Cortland, NY)
- Position Summary: This is an integrated Case Management and Utilization Review position. The Acute Care Case Manager utilizes industry accepted processes ... based on assessed needs and available resources. The Acute Case Manager also performs Utilization Management...outcome data and or problematic issues. Other Duties: 1. Travel for this position is sometimes required. 2. Participation… 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
- Houston Methodist (Houston, TX)
- …for state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement ... Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated… more
- Health First (Palm Bay, 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
- Amergis (Palo Alto, CA)
- …Palo Alto, CA Start date: 2/3 Duration: 13 weeks, possible extensions Unit: Case Management Inpatient Shift: Days Hours: 4x10s, 40 hours/week Requirements: CA ... Manager experience + BLS + EPIC experience + Previous Travel RN exp. + BSN RN preferred Details: Location:...services + Follows State/County mandated guidelines for the nurse case management programs + Participates in outreach… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case ... management and social work department to facilitate efficient utilization of resources and discharge planning including referrals ...administrative duties of a higher complexity in support of Case Management operations. In addition, the CM… more
- Health First (Melbourne, FL)
- *POSITION SUMMARY* The Case Management Support Specialist position is responsible for providing Quality/No Harm, Customer Experience, and Stewardship by ensuring ... for hospital stays. Provide support with all discharge planning functions within the Case Management department. Be flexible in fulfilling various roles, putting… more
- State of Massachusetts (Brockton, MA)
- …Mental Health's Brockton Multi Service Center (BMSC) is seeking an experienced Adult Case Management Supervisor (Human Service Coordinator II) to join the team. ... The Adult Case Management Supervisor will: orient, train and...compliance with DMH Regulations, policies, and procedures. * Conduct utilization management reviews as well as audit… more
- United Therapeutics (Columbus, OH)
- …pulmonary diseases, and other orphan diseases. **How you'll contribute** The Associate Global PV Case Management Director plays a key role in management and ... processing for commercial UT products, including PM GSD workflows; Maintain unified PM Case Management operating procedures and monitor systems to ensure all PM… more
- LifePoint Health (Rutherfordton, NC)
- …knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of Case ... Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization ...from admission through discharge. Educates Physicians and staff in Case Management standards and assists them in… more
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