- Prisma Health (Greenville, SC)
- …capabilities. Strong collaboration among a dedicated team including physicians, surgeons, nurses, case management , therapy and social work to provide consistent ... utilization of unit resources. Shares accountability with Nurse Manager for unit/department/organizational goal achievement.Assists in planning, directing, and… more
- Sharp HealthCare (San Diego, CA)
- …+ Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) - American Case ... CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management... Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized… more
- Sharp HealthCare (San Diego, CA)
- …(MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case ... CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management...in Healthcare or a related field + 3 Years Utilization Management or case … more
- Sharp HealthCare (San Diego, CA)
- …experience or case management experience + 3 Years recent case management , utilization review, care coordination experience + California Registered ... Master's Degree in Nursing; Bachelor's Degree in Nursing; Certified Case Manager (CCM) - Commission for ...competency and individual development planning process.Maintain current knowledge of case management , utilization management… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection...of patient data and treatments. Communicates daily with the Case Manager to manage level of care… more
- Trinity Health (Silver Spring, MD)
- …/supervision/leadership experience in an acute healthcare setting required, preferably with case management , utilization review or closely related ... **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision...RN with BSN or RN with > 10 years case management experience. Masters Degree preferred. **Minimum… more
- Covenant Health (Nashua, NH)
- …of the health care team. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current knowledge of UR ... + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager +...Minimum of five years broad clinical experience preferred + Case management and/or Utilization … more
- LifePoint Health (Danville, VA)
- *Registered Nurse, RN - Utilization Review Case Manager * Job Type:Full Time|Days *$10,000 Sign-on Bonus Eligibility for Full-Time, Bedside RNs* ** Must have ... . Professional development and growth opportunities *Department/Unit Summary* Our Case Management Department primarily serves the adult...offering safe discharge planning is the use of a Utilization RN and Case Manager … more
- Helio Health Inc. (Syracuse, NY)
- …efforts to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ... provided by the hiring manager and program Job LocationsUS-NY-Syracuse Category Case Management Position Type Full-Time Work Arrangement Onsite ID 2024-4457 more
- Sharp HealthCare (San Diego, CA)
- …and refer members to case management or quality management as appropriate for utilization or quality issues while maintaining department ... of need for further management , communicates this to the appropriate Case Management Program per UM policy.Gathers pertinent information to provide … more
- Trinity Health (Mason City, IA)
- …its goals **Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case ... of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized...insurance coverage for acute care and skilled care + Case management experience preferred Special Skills and… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager , you will play a key role in processing ... a vital role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the… more
- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- VNS Health (Manhattan, NY)
- …Degree or equivalent work experience in management for a health plan or utilization / case management Required Master's Degree in Nursing or Health Care ... related field, including three years of progressive experience in case or utilization Management Required...years of progressive experience in case or utilization Management Required Effective oral/written communication and… more
- Trinity Health (Silver Spring, MD)
- …BSN required; MSN Degree preferred. + At least 3 years of experience in hospital case management or related activity. + Minimum of 1-3 years management ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible...required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At… more
- Providence (Mission Hills, CA)
- **Description** The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management ... The Manager assists the Regional Director of Utilization Management , Appeals & Clinical Training through...Degree in Nursing or other related area + Coursework/Training: Case Management Certification + 2 years minimum… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager...unrestricted RN license in OH. + 3+ years of utilization / case management experience in relevant ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- Elevance Health (FL)
- **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization ... providers to discuss plan benefits and alternative services; manages case consultation and education to customers and internal staff...Candidate will be responsible for the oversight of the utilization management team. + Responsible for a… more
- Humana (Salem, OR)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... (BSN) degree required + Five or more years of utilization management required + Four or more...travel/attend off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified… more
