- Kaiser Permanente (Fontana, CA)
- …the interdisciplinary approach to providing continuity of care, including Utilization management , Transfer coordination, Discharge planning, and obtaining ... Center in Victorville.Kaiser Permanente Job ID #1284807. Posted job title: Case Manager Utilization Rn- Per Diem Day, Onsite VictorvilleAbout Kaiser PermanenteAt… more
- Kaiser Permanente (San Francisco, CA)
- … and Medi-Cal benefits to specific patient situations.Participates in Utilization Management /Quality Assurance activities.Assist in coordinating communication ... to the patients illness. Under general direction of the Social Work Manager /LCSW, delivers age-appropriate social work care to patients and their caregivers in… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Trinity Health (Darby, PA)
- …with the RN Care Coordination Manager , provides support to the utilization management , denials and appeals process for the THMA South hospitals. ... support to the Emergency Department Case Manager , Utilization RNs, and Utilization Management ...external managed care (IBC, Aetna, etc.) and regulatory organizations ( Medicare , Medicaid, etc.) when necessary + Ensures appropriate flow… more
- Centene Corporation (IN)
- … Medicare Operations, Clinical, Pharmacy, Call Center, Provider Data, Utilization Management , Case Management , Data Analytics.:** ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CareFirst (Baltimore, MD)
- …in the Medicare Advantage Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales, and ... (strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the team in… more
- Providence (Beaverton, OR)
- …the best people, we must empower them._** **Providence Health Plan is calling a Manager Utilization Management RN, Prior Authorization who will:** + Be ... for Management and supervision of the PHP Utilization Management (UM) or Care Management...Acceleration Process (CAP) experience + Experience with HEDIS, CAHPS, Medicare 5-Star Rating, NCQA and/or URAC accreditation **Why Join… more
- The Cigna Group (Nashville, TN)
- …and specialist appointment scheduling. + Provide clinical assessments, health education, and utilization management to customers, as needed. + Initiate contact ... to facilitate appropriate health care outcomes for customers. Ensures that case management program objectives are met by evaluating the effectiveness of alternative… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ Comprehensive knowledge of utilization management , financial management that includes revenue cycle, Medicare , Medicaid, and commercial admission ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… more
- The Cigna Group (Bloomfield, CT)
- …quality care is maintained. Provides clinical assessments, health education, and utilization management to members. Performs prospective, concurrent, and ... + **Job Description** + This position, the Nurse Case Manager Senior Analyst, through the case management ...**Position Scope:** + Manages/coordinates an active caseload of case management cases for Cigna Medicare . Uses clinical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...performing UM and CM at a medical group or management services organization. Experience with Managed Medi-Cal, Medicare… more
- The Cigna Group (Bloomfield, CT)
- …and specialist appointment scheduling. + Provide clinical assessments, health education, and utilization management to customers, as needed. + Initiate contact ... of three or more years experience in acute care, home health or case management experience. + Medicare and/or Medicaid experience with geriatric populations a… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- Guidehouse (Gardena, CA)
- …**What You Will Do** **:** The **Insurance Patient Account Representative - Medicare Emphasis** is an extension of a client's business office staff. Representatives ... from home._** **_Questions regarding this position, you may contact Chris Rivera ( Manager , Talent Acquisition) at ###_** **Essential Job Functions** + Medicare … more
- Trinity Health (Syracuse, NY)
- …10,000 sign-on retention bonus for qualified experienced RN's. The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the ... utilization review process and patient progression from Admission to...to determine appropriate patient status/level of care. + Follows Medicare guidelines and industry standards to ensure the proper… more
- The Cigna Group (Tucson, AZ)
- Pima County based - Medicare Provider Performance Enablement (PPE) Senior Analyst provides broad support to Sr. Supervisor, Sr. Manager , Director, and Other ... interaction with PPE staff as well as other Cigna Medicare departments. Position is exposed to all aspects of...provider demographic records by validating and submitting all data management requests for completion. + Prepare for and participate… more
- The Cigna Group (Baltimore, MD)
- …provider group improvement plans autonomously, with expert-level technical support from manager . + Knowledge of quality and affordability metrics and tools; ... effective communication to inform external partners. + Supporting the development, management and oversight of the physician/ provider network in his/her assigned… more
- Hackensack Meridian Health (Hackensack, NJ)
- …a. Provides direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight for accurate patient ... vs. Inpatient c. Liaison to the Medical Staff supporting Utilization Management Committee processes d. Hospital Based...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Humana (Tallahassee, FL)
- **Become 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
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure *Insurance and Utilization Management *Maintains working knowledge of CMS requirements and ... starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE MANAGEMENT (Billings Clinic… more
