- Alameda Health System (Oakland, CA)
- …plans Role Overview: Alameda Health System is hiring! The Director of Utilization Management holds a critical role encompassing operational oversight, strategic ... adapting to ad hoc duties as needed. In essence, they orchestrate efficient utilization management to deliver high-quality patient care. DUTIES & ESSENTIAL JOB… more
- Harbor Health Services, Inc. (Mattapan, MA)
- …for more than 580 participants. We are currently seeking a Director of Utilization Management & Quality Programs. Harbor Health offers an excellent, ... the Senior Director of Health Plan Operations, the Director of Utilization Management and Quality Programs is responsible for the day-to-day support, direction… more
- Valley Health System Consolidated Services (Las Vegas, NV)
- …outcomes by establishing a safe, individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is ... years experience in varied clinical settings. Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant… more
- Valley Health System Consolidated Services (Las Vegas, NV)
- …outcomes by establishing a safe, individualized discharge and providing proficient timely utilization management services to ensure that maximum reimbursement is ... years experience in varied clinical settings. Two years experience in Utilization Review, Utilization Management or Case Management preferred. Applicant… more
- Mercy (St. Louis, MO)
- …required Experience: * 2-3 years acute care hospital setting, preferred. * Care Management or Utilization Management experience, preferred Licensure: * ... the Mercy mission, values, and service standards. The Care Management model provides effective transition planning and length of...within 90 days of hire * Certification in Case Management , Preferred Why Mercy? From day one, Mercy offers… more
- ChristianaCare (Newark, DE)
- …plan. Social Worker - Resolves psycho-social barriers and supports discharge needs. Utilization Management - Reviews patient status for appropriateness and ... throughout the care continuum and discharge planning. The Care Management Model: Our Care Management Triad Team Model is a collaboration between the following:… more
- Mercy (Washington, MO)
- …Case Management Preferred Experience: 2 years acute care hospital setting Care Management or Utilization Management experience Why Mercy? From day one, ... Mercy offers outstanding benefits - including medical, dental, and vision coverage, paid time off, tuition support, and matched retirement plans for team members working 32+ hours per pay period. Join a caring, collaborative team where your voice matters. At… more
- University of New Mexico - Hospitals (Alameda, NM)
- …limited to experience, education, and other business and organizational considerations. Department: Utilization Management - UH FTE: 1.00 Full Time Shift: Days ... appropriate patients within designated specialty area requiring patient case management interventions by utilizing established procedures including census review,… more
- Overlake (Bellevue, WA)
- …Two years inpatient case management experience preferred Prior case management , utilization management , and/or payer experience required. Ability ... to effectively present information and respond to questions from groups of managers, patients, physicians, and payors. Effective verbal and written communication skills and computer skills. Why join Overlake? We're proud to offer benefits that support you in… more
- Mercy (Joplin, MO)
- …in Case Management Preferred Experience 2 years acute care hospital setting Care Management or Utilization Management experience Why Mercy? From day one, ... consistent with the Mercy mission, values, and service standards. The Care Management model provides effective transition planning and length of stay oversight to… more
- MVP Health Care (Rochester, NY)
- …in every interaction Your key responsibilities: Utilize the essentials of an integrated utilization management and case management model that includes ... and accreditation standards (eg, NCQA), including documentation and reporting. Cost Management : Monitor service utilization to maintain cost-effectiveness and… more
- MVP Health Care (Tarrytown, NY)
- …use) with children and/or adolescents, with at least 2 years being ASD related Utilization or Case Management experience in a managed care organization is ... Workplace . The Behavioral Health (BH) Professional is responsible for conducting utilization review for mental health and substance use treatment decisions. This… more
- University Health (Hondo, TX)
- …minimum three years of clinical nursing experience is required. Data entry, referral management , utilization management experience is required. Case ... Management experience preferred. Experience in a similar setting and working with OB patients preferred. Experience working with EPIC EMR desirable. LICENSURE/CERTIFICATION Current licensure in the State of Texas as an RN or LVN is required. more
- MVP Health Care (Rochester, NY)
- …benchmarks. Work closely with all other MVP departments, especially Quality, Operations, Utilization Management , Sales and Professional Relations. Off call work ... may include service issue research and resolution, reporting, special projects, etc. Performs other duties as assigned. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of… more
- ChristianaCare (Newark, DE)
- …health information technology, performance improvement, outcome analysis, safety science, utilization management , population health Proficiency in using ... statement, goals, scope, timeline, and critical milestones utilizing project management methodologies, performance measurements, and tools. Manage the work defined… more
- Carle Health (Urbana, IL)
- …Management Services as defined in the Illinois Pharmacy Practice Act. Performs utilization management reviews. Serves as drug information resource for other ... departments. Conduct medication reconciliation, perform clinical interventions, uncover adverse drug reactions, and refer patients to pertinent clinics (ie anticoagulation). About Us Find it here. Discover the job, the career, the purpose you were meant for.… more
- University Health (Boerne, TX)
- …years recent, full time hospital experience preferred. Work experience in case management , utilization review, or hospital quality assurance experience is ... and clinicians in the Ambulatory setting by gathering information, coordinating utilization efforts, and reviewing HCC quality indicators, and RAF scores to… more
- University Health (Pleasanton, TX)
- …required (as a Staff nurse II or above). Work experience in case management , utilization review or hospital quality is preferred. LICENSURE/ CERTIFICATIONS ... with the Texas State Board of Nurse Examiners is required. An approved case management certification (ACM, CCM or ANCC) is preferred and must be achieved within two… more
- Life Care Center of Post Falls (Post Falls, ID)
- …year of clinical experience in post-acute care setting preferred Prior case management , utilization review, and discharge planning experience preferred Specific ... other providers of care Implement the standards of practice for care management , ethical performance, and functions relevant to coordination of care Exhibit… more
- University Health (Pleasanton, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience is ... preferred. Must complete a Clinical Documentation Improvement Course within specified time of hire date. LICENSURE/CERTIFICATION Current license from the Board of Nurse Examiners of the State of Texas to practice as a registered nurse is required. National… more
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