- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los ... required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically… more
- State of Indiana (Indianapolis, IN)
- … management subject-matter expert in health care delivery, develops utilization management reporting requirements for all Medicaid programs, ... utilization review, clinically appropriate care and risk management for the purpose of quality assurance...including managed care and analyzes and evaluates the reporting to determine impact on members and providers as… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...management . + Advanced skills in data analysis and reporting and strategic planning. + Experience in clinical system… more
- George C. Grape Community Hospital (Hamburg, IA)
- …years of clinical nursing experience (acute care preferred). o Prior experience in utilization review, case management , quality improvement, and infection ... Quality / Utilization Review Nurse Position Summary: The...& Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and infection control standards.… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- McLaren Health Care (Port Huron, MI)
- …hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient outcomes/ quality ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …of or ability to learn financial management related to UR function and reporting , quality improvement processes, and human resources management * Able to ... review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical,… more
- Huron Consulting Group (Chicago, IL)
- …Management and works with hospital leadership to coordinate and integrate utilization management activities, using continuous quality improvement ... and reporting to verify outcomes, effectiveness of utilization management activities and appropriate use of...stay and level of care, while promoting cost-effective and quality patient care. Position is located in Annapolis, MD… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …- REVISED FTE *_SUMMARY:_* We are currently seeking a*Staff Nurse*to join our Utilization Management department for the/Emergency Department / This position is ... *Assessment:* * Collects, reviews, and documents clinical data relevant to utilization management , including patient status, treatment plans, and healthcare… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination ... of business. **Knowledge, Skills and Abilities (KSAs)** + Oversight of Utilization Management clinicians while championing process improvement, change adoption… more
- Elevance Health (Tampa, FL)
- …required by law. *Must reside in the state of Florida* The **Manager of Utilization Management ** is responsible for managing a team of physical and/or behavioral ... health practitioners responsible for coordinating member service, utilization , access, care management and/or concurrent review to ensure cost effective … more
- Prime Healthcare (San Dimas, CA)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting . Able to work independently ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Connect With Us! (https://careers-primehealthcare.icims.com/jobs/234286/ utilization -review-coordinator utilization -… more
- Saint Francis Health System (Tulsa, OK)
- …not all inclusive nor does it prohibit the assignment of additional duties. Utilization Management - Laureate Campus Location: Tulsa, Oklahoma 74136 **EOE ... of care process improvement. Identifies QI Triggers for individual patient situations, reporting them promptly to the Process Improvement/ Quality Director, to… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing… more
- Community Health Systems (Naples, FL)
- … utilization review activities, trends, and outcomes to support regulatory and quality reporting requirements. + Supports utilization review team ... Join us as a **Registered Nurse (RN) - Utilization Review position** at Physicians Regional Collier Unit: Utilization Review Shift: Mon-Fri (this is an onsite… more
- Healthfirst (NY)
- …and regulatory requirements** + **Deliver on Healthfirsts Mission by ensuring optimum quality of member care in a cost-effective manner** + **Ensure UM operations ... maintain and improve department performance** + **Collect, analyze, and report on utilization trends, patterns, and impacts to identify areas for improvement** +… 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
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review, case management , quality improvement, and related policy and ... direction to medical staff in their efforts to ensure quality patient care and the appropriate utilization ...utilization of medical services. The Medical Director of Utilization Management serves as a key liaison… more
- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management ... for assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... in department and hospital performance improvement activities; Responsible for outcomes reporting , quality , and Lean process improvements, and facilitating the… more