- LA Care Health Plan (Los Angeles, CA)
- …in a case/care management environment. Preferred: Experience in utilization review , skilled nursing, home health , discharge planning, behavioral ... and coordination of psychosocial wraparound services to promote effective utilization of available Health Plan, Home...home care, or case management. OR experience in Utilization Review or Care Management will be… more
- 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
- 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
- Sanford Health (MN)
- **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 ... 50,000 members of the Sanford Family who are dedicated to the work of health and healing across our broad footprint.** **Facility:** Remote MN **Location:** City -… more
- Centene Corporation (Madison, WI)
- …related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience ... SOME FLEXIBILITY AFTER SUCCESSFULLY COMPLETING TRAINING.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Ascension Health (Manhattan, KS)
- … health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within ... healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee...across a number of hospitals, clinics, therapy centers and home health services. Ascension is a leading… more
- Ascension Health (Milwaukee, WI)
- … health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests within ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …1. Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... a seamlessly connected system offering quality care close to home . From basic health needs to the...appropriate status determination. 2. Ensures compliance with principles of utilization review , hospital policies and external regulatory… more
- 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
- Geisinger (Danville, PA)
- …key role in ensuring information is released to payers and physician level review . Frequently works with highly sensitive and confidential information. Job Duties + ... a resource to departmental staff regarding insurance contacts. + Maintains Utilization management SharePoint site to reflect updated payor information. +… more
- 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
- 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
- Providence (Anchorage, AK)
- …planning, coordinating, and directly supervising the activities of the case management, utilization review , social services and navigation teams for assigned ... Managers upon hire + 2 years of Case Management experience including utilization review , care management, care coordination, discharge planning, or population… more
- 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
- LA Care Health Plan (Los Angeles, CA)
- …providing clinical review and authorization for alternate levels of care, home health , durable medical equipment, and other discharge needs. Provides support ... but not limited to: Skilled nursing facility, outpatient needs ( home health , physical therapy, infusion), and case...Utilization Management or CM. Knowledge of Department of Health Care Services (DHCS) or Centers for Medicare and… more
- ChenMed (Louisville, KY)
- …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
- 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
- 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
- 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
- AmeriHealth Caritas (Dublin, OH)
- …and impact on services including but not limited to, prior authorization, inpatient review , discharge planning, home health , and SNF/Rehabilitation Services. ... now. We are looking for the next generation of health care leaders. At AmeriHealth Caritas, we are passionate...preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review ,… more
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