- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management, the Nurse Utilization Management (UM) Reviewer ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...RN **Desired Licensing (nice to have):** + CCM (Certified Case Manager ) **Required Experience (must have):** +… more
- Stanford Health Care (Palo Alto, CA)
- …work at Stanford Medicine | Stanford Health Care (SHC)? Are you a seasoned RN Case Manager ? Here is your opportunity to work with the Timely Discharge Department ... include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review ...improvement activities that lead to optimal patient outcomes. A Case Manager differs from other roles in… more
- University of New Mexico - Hospitals (Corrales, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * TREATMENT ... outcomes are achieved within established time frames and with efficient utilization of resources. Conduct initial and ongoing assessments, initiate disease… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... and performance/quality improvement activities that lead to optimal patient outcomes. A Case Manager differs from other roles in professional nursing/health care… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE ... - UH FTE: 1.00 Full Time Shift: Days Position Summary: Responsible for the initial review , triage and assignment of patients to case managers and for the… more
- Battelle Memorial Institute (Tampa, FL)
- …Research and Analytics (HRA) business line is seeking a highly motivated, full-time **Nurse Case Manager ** to join our team in support of our government ... comprehensive support for those who serve. As a Nurse Case Manager , you will contribute to impactful...professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report… more
- Stony Brook University (Stony Brook, NY)
- RN Case Manager **Position Summary** At Stony Brook Medicine, a **RN Case Manager ** is a valuable member of our team, who provides clinical services to ... our high standard of excellence. **Duties of a RN Case Manager in the Care Management Department...the following but are not limited to:** + Completes Utilization review screen for inpatient and observation… more
- Luke Staffing (Agana Heights, GU)
- …Government and professional clinical standards and clinical protocols. . Participate in Utilization Management/ Case Management meetings to review and ... **INDEPENDENT LICENSED SOCIAL WORKER CASE MANAGER ** **SITE OF SERVICE:** ....of newly assigned unit personnel. . Collaborate in the review of unit standing operating procedures. . If directed,… more
- Interim HealthCare (Greenwood, IN)
- …as a Registered Nurse (RN) in home health or similar setting; previous case management/ utilization review experience preferred. OASIS experience preferred. ... your community, you'll change lives every day. As a Registered Nurse Case Manager (RNCM), you will: Conduct In Person patient interviews and comprehensive… more
- ERP International (Luke AFB, AZ)
- … Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... utilization of resources. Monitors and evaluates the facility's case management program per DoD, AF and local policies...as a Registered Nurse, any state. Clinical Certification:** Certified Case Manager by Commission for Case… more
- Commonwealth Care Alliance (Boston, MA)
- …support consistency and quality across BH and Health Home providers. - Participate in case review meetings and rounds as needed to enhance coordination and care ... Position Summary: The Behavioral Health (BH) Provider Engagement Program Manager is responsible for cultivating strong, collaborative relationships with behavioral… more
- Stanford Health Care (Menlo Park, CA)
- …which includes strategic planning, financial performance management, resource utilization , contract administration, operational metrics, lease administration, and ... description below and apply online. **A Brief Overview** The Senior Project Manager is responsible for managing the programming, planning and activation of complex… more
- Molina Healthcare (Houston, TX)
- …Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of ... oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical… more
- University Health (San Antonio, TX)
- …preferred. Three years recent, full time hospital experience preferred. Work experience in case management, utilization review , or hospital quality assurance ... a registered nurse is required. National certification in related field is desirable. Case Manager Certification (CCM, CPHQ, or ANCC) or Certified Diabetes Nurse… more
- Katmai (Fort Carson, CO)
- …+ Identify cases that may benefit from alternative levels of care and involve the case manager as needed to provide direction in care management. + Plan and ... prioritize utilization review (UR) activities to ensure identified patient needs are addressed promptly. + Effectively utilize information systems to develop,… more
- Katmai (Fort Carson, CO)
- …and providers, network/outside providers and ancillary healthcare workers. + Apply principles of utilization review (UR) and utilization management (UM) in ... + Identify cases that may benefit from alternative levels of care and involve the case manager as needed to provide direction in care management. + Plan and… more
- Hawaiian Electric (Honolulu, HI)
- …portfolio managers in all aspects of documenting project ideas, developing business case analyses for those ideas, prioritizing project ideas for approval, and ... and Project Management tools; (3) assisting with facilitation of the Project Review Committee (PRC) and communication of information (status, progress, health) about… more
- University Health (San Antonio, TX)
- …preferred. Three years recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance ... practice as a registered nurse is required. National certification in related field is preferred. Case Manager Certification (CCM or ANCC) is highly desirable. more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- Eastern Connecticut Health Network (Manchester, CT)
- POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician and interdisciplinary team to support the ... in the acute-care setting. + Minimum of 1 year Utilization Review experience preferred via industry clinical...Care and status on all patients through collaboration with Case Manager . + Demonstrates thorough knowledge in… more
