- Penn Medicine (Lancaster, PA)
- …and thrive under pressure, we'd love to hear from you!_ **Summary** : The Utilization Management Specialist - Admissions is responsible for evaluating ... is looking for an experienced RN to join our Utilization Management Specialist team! In this critical...class in accordance with industry guidelines. Serves as a liaison for patients and hospital with insurance companies. **Qualified… more
- Cedars-Sinai (Los Angeles, CA)
- …Assists with investigation and follow-up regarding customer complaints. + Serves as liaison with other units in the Admissions department. **Qualifications** ... of service cash collections and cash flow, and provide efficient and appropriate utilization of resources. Acts as a resource for team members by assisting with… more
- University of Rochester (Rochester, NY)
- …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500016 Admissions Center-SMH Work Shift: UR - Day (United States of America) Range: UR ... equity considerations._ **Responsibilities:** Coordinates or manages inpatient and outpatient admissions , including bed assignments and the completion of preliminary… more
- University of Rochester (Rochester, NY)
- …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500016 Admissions Center-SMH Work Shift: UR - Rotating (United States of America) Range: ... financial eligibility, secures account for billing and coordinates account management through discharge Completes appropriate forms to complete Death Certificate… more
- Calvary Hospital (Bronx, NY)
- …pertinent data. 8. Knowledge of and experience in Quality Assessment and Improvement, Utilization Review. 9. Ability to develop management systems to track data ... Outreach, Admitting and Intake implementing changes when appropriate. Acts as liaison between Calvary Hospital and referring institutions and providers. Actively… more
- UTMB Health (Webster, TX)
- …efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions, ... UTMB TDCJ Hospital to specialty services hospitals. **_ESSENTIAL JOB FUNCTIONS_** **:** Utilization Management + Demonstrates thorough knowledge of Inter Qual… more
- St. Peters Health (Helena, MT)
- …and supportive liaison and educator to providers and staff around utilization management principles. This professional role will be responsible for: 1. ... The Utilization Management RN reports directly to...Facilitation of peer to peer calls for both hospital admissions and for specific outpatient service denials as assigned,… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- Martin's Point Health Care (Portland, ME)
- …experience as an RN, preferably in a hospital setting + 2+ years of utilization management experience in a health plan UM department Required License(s) and/or ... been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high quality,… more
- Wellpath (Cleveland, OH)
- … utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and ... **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization...to reduce length of inpatient stays and decrease ED admissions . + Evaluate and recommend policy improvement related to… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …management committee, in defining operational strategic objectives for the Utilization Management Program and serves as the liaison to other medical staff ... * Act as physician liaison between case management / utilization management and providers to...* Review and report on PEPPER metrics; (LOS, CMI, Re- admissions , OBS rates, and governmental audit measures) to Hospital… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Mount Sinai Health System (New York, NY)
- …limited to: a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case Manager (CM) will...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …+ Strong commitment to teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations + Ability to work ... As our Case Management Nurse, you will serve as an effective liaison between our facility and payers to optimize patient/family reintegration into the community.… more
- Logan Health (Kalispell, MT)
- Logan Health Wellness & Pain Management is proud to offer some of the most comprehensive pain and wellness care in the United States. Job Description Summary Logan ... Health Wellness and Pain Management is looking for an LCSW, LCPC or LMFT...Duties: + Triages referrals from providers and ensures on-going liaison occurs with stakeholders as applicable to assigned area(s).… more
- Community Health Systems (Hattiesburg, MS)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... laws and Joint Commission standards. + Acts as a liaison to community agencies, providing resources and services for...experience required + 3-5 years of experience in care management or utilization review required + 1-3… more
- University of Washington (Tacoma, WA)
- …responsible for managing day-to-day operations for the academic unit and overseeing management of faculty and staff human resources, internal and external events, ... facilities/space/equipment utilization , finance, and academic programs. Reporting to the Dean...day-to-day operations for Nursing and Healthcare Leadership. + Oversee management of agency contracts, and faculty and student clinical… more
- University of Southern California (Arcadia, CA)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation, and discharge planning functions. The ... follows up to resolve problems with payers as needed. + Completes utilization management for assigned patients. + Coordinates/facilitates patient cares… more
- HCA Healthcare (Gainesville, FL)
- …to decisions regarding ER and interfacility transfer patients. + Serves as first line liaison for problem solving for Bed Management . + Actively functions as ... an on-going focus on quality and efficiency. + Screens admissions for appropriateness of level of care and bed...the patient flow program effectiveness as it relates to utilization review, resource management , and discharge planning… more
- Community Health Systems (Granbury, TX)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... Life and disability insurance and more **Job Summary** The Director, Care Management is responsible for overseeing the implementation, development, and management… more
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