• Acute Nurse Case Manager

    ChenMed (St. Louis, MO)
    …clinical work experience required + A minimum of 1 year of utilization review and/or case management, home health , discharge planning experience required ... other case managers and nurses, acute and post-acute facilities, home health companies, and health ...discharge planning. **KNOWLEDGE, SKILLS AND ABILITIES:** + Knowledge of Utilization Review (UR) and discharge planning +… more
    ChenMed (10/01/24)
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  • Medical Director of Utilization

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient...care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye… more
    Henry Ford Health System (11/06/24)
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  • Utilization Review Specialist Senior

    BayCare Health System (Clearwater, FL)
    …and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands...team. **The Utilization Review Specialist Senior responsibilities include:** +… more
    BayCare Health System (10/14/24)
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  • Utilization Review Clinician…

    Centene Corporation (Madison, WI)
    …related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience ... role have the flexibility to work remotely from their home anywhere within the Eastern or Central time zone...or Central time zone **Position Purpose:** Performs a clinical review and assesses care related to mental health more
    Centene Corporation (11/21/24)
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  • ABA Utilization Review (UR)…

    Spectrum Billing Solutions (Skokie, IL)
    …computer skills (Word, Excel, billing software). + Understanding of mental and behavioral health treatment services. Utilization Review Specialist | ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...+ Flexible work environment - You can work from home , hybrid or fully in office. + Competitive Salary… more
    Spectrum Billing Solutions (11/16/24)
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  • Utilization Review Specialist - PRN

    Munson Healthcare (Traverse City, MI)
    …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... + Minimum of three years clinical experience required. Previous utilization review and/or case management in a...able to adapt to required software programs which support Utilization Management functions. Familiarity with health care… more
    Munson Healthcare (11/09/24)
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  • Manager, Care Coordination - Utilization

    Stanford Health Care (Palo Alto, CA)
    …processes between Health System and post-hospitalization service providers ( Home Health Agencies, Extended Care Facilities, Durable Medical Equipment ... and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. +… more
    Stanford Health Care (11/20/24)
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  • Support Specialist- Utilization

    Henry Ford Health System (Troy, MI)
    The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... payers as needed. * Maintain a current knowledge of Utilization Management through interaction with staff and payor portal...care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye… more
    Henry Ford Health System (11/20/24)
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  • Utilization Management Coordinator…

    Sanford Health (ND)
    **Careers With Purpose** **Sanford Health is one of the largest and fastest-growing not-for-profit health systems in the United States. We're proud to offer many ... members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.** **Facility:** Remote ND (Central Time) **Location:**… more
    Sanford Health (11/21/24)
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  • Case Manager RN - Kodiak Utilization

    Providence (Kodiak, AK)
    …for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, ... and standards. The Case Manager/RN Navigator partners with the Utilization Review nurse, patients, physicians, and interdisciplinary...The Providence family of organizations has a vision of health for a better world. As such, we are… more
    Providence (11/22/24)
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  • Utilization Review RN…

    Providence (Mission Hills, CA)
    **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records ... daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and… more
    Providence (11/25/24)
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  • Utilization Review Social Worker

    HCA Healthcare (Ogden, UT)
    …charitable organizations. Apply Today! **Job Summary and Qualifications** The Mental Health Professional/ Utilization Review role primarily involves reviewing ... Center, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The...in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with… more
    HCA Healthcare (10/31/24)
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  • Utilization Review Nurse

    US Tech Solutions (Columbia, SC)
    health /chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years must ... WEEK AND THEN WILL BE DEPLOYED TO WORK FROM HOME . WILL PROVIDE THE EQUIPMENT. + NICE TO HAVE...in direct intervention/patient education with members and providers regarding health care delivery system, utilization on networks… more
    US Tech Solutions (10/31/24)
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  • Manager, Utilization Management Operations-…

    VNS Health (Manhattan, NY)
    …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with...of care begins with you. Together, we will revolutionize health care in the home and community.… more
    VNS Health (10/09/24)
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  • Acute Care RN

    ChenMed (Philadelphia, PA)
    …work experience required. + A minimum of 1 year of utilization review and/or case management, home health , hospital discharge planning experience ... other case managers and nurses, acute and post-acute facilities, home health care companies, and health...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
    ChenMed (11/26/24)
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  • Utilization Management Nurse Consultant

    CVS Health (Austin, TX)
    …+ 2+ years of clinical experience as an RN (all clinical areas considered: Home Health , Med/Surg, Telemetry, ICU, NICU, Long term care, orthopedics, and more) ... Bring your heart to CVS Health . Every one of us at CVS ...Word, Excel, Outlook) Preferred Qualifications: + 1+ years' experience Utilization Review experience + 1+ years' experience… more
    CVS Health (11/21/24)
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  • RN- Utilization Management

    ERP International (Nellis AFB, NV)
    …the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
    ERP International (11/02/24)
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  • Medicaid Utilization Analyst 9-12 - Bphasa…

    State of Michigan (Lansing, MI)
    …etc. (eg nursing/therapy services); or; one year of professional experience analyzing health services or health services utilization data equivalent ... etc. (eg nursing/therapy services); or; two years of professional experience analyzing health services or health services utilization data equivalent… more
    State of Michigan (11/25/24)
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  • Utilization Management Director (Hybrid)

    CareFirst (Baltimore, MD)
    …medical pre-authorization review , Commercial inpatient and outpatient behavioral health review , Medicare intake and medical pre-authorization review ... expected to work a portion of their week from home and a portion of their week at a...shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization more
    CareFirst (11/26/24)
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  • Utilization Management RN (mostly remote)

    VNS Health (Manhattan, NY)
    …AT VNS Health The future of care begins with you. Together, we will revolutionize health care in the home and community. When you join VNS Health , you ... member needs and identifies solutions that promote high quality and cost-effective health care services. Manages providers, members, team, or care manager generated… more
    VNS Health (11/05/24)
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