- Trinity Health (Darby, PA)
- …Type:** Full time **Shift:** Day Shift **Description:** The Appeals and Utilization Management Coordinator under direction and in collaboration with ... process for the THMA South hospitals. The Appeals and Utilization Management Coordinator ensures the delivery of effective and efficient patient care… more
- CVS Health (Carson City, NV)
- …customer service or audit experience. Experience in research and analysis of utilization management systems. Preferred Qualifications Knowledge of Fast Track ... affordable. Position Summary Responsible for managing to resolution of Fast Track Appeals for Medicare products, which may contain multiple issues and, may require… more
- Centene Corporation (IA)
- …experience or LPN/LVN with 5+ years of clinical nursing or case management experience. Managed care or utilization review experience preferred. ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Penn Medicine (Philadelphia, PA)
- … appeals correspondence. + Maintains database for the department and the utilization management requirements for the hospital information system and within ... of communication. + Supports the activities of the Clinical Appeals Coordinator in all phases of the... in all phases of the Clinical Quality and Utilization Management functions including but not limited… more
- Hackensack Meridian Health (Brick, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator ** , ** Utilization Management ** is a member of the healthcare team ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Neptune, NJ)
- …and serve as a leader of positive change. The **Care Management , Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and serve as a leader of positive change. The **Case Management Care Coordinator , Utilization Management ** is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Edison, NJ)
- …healthcare and serve as a leader of positive change. The Case Management Care Coordinator , Utilization Management is a member of the healthcare team and ... of the patient's treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- Hackensack Meridian Health (Edison, NJ)
- **Overview** The Care Management , Care Coordinator , Utilization Management is a member of the healthcare team and is responsible for coordinating, ... of the patient?s treatment. Accountable for a designated patient caseload; the Care Coordinator , Utilization Management plans effectively in order to manage… more
- State of Connecticut, Department of Administrative Services (Wallingford, CT)
- Utilization Review Nurse Coordinator Hybrid Recruitment # 240624-5613FP-001 Location Wallingford, CT Date Opened 6/27/2024 12:00:00 AM Salary $86,261 - ... has a full-time (1st shift) job opportunity for a Utilization Review Nurse Coordinator (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5613FP&R1=&R3=) , in… more
- Trinity Health (Livonia, MI)
- …/ MCG criteria to determine appropriate level of care. * Follows the hospital Utilization Review Plan to ensure effective and efficient use of hospital services. * ... to determine if a case should go to the Appeals Team. * Assists other departments in the reimbursement...appropriate and communicating to Insurance Verification and Health Information Management . * Functions as a resource to physician, hospital… more
- Huron Consulting Group (Chicago, IL)
- …the utilization management system. + Generate and analyze reports on utilization trends, denials, and appeals to identify areas for improvement. + Ensure ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...discussions. + Hold weekly 1:1 meetings with the Senior Coordinator and conduct Staff 1:1's to provide support and… more
- Hartford HealthCare (Southington, CT)
- …of Connecticut's most comprehensive healthcare network as a Quality Improvement Coordinator . Hartford HealthCare at Home, the largest provider of homecare services ... clients and their clients' families. Basic Purpose of the Position: **Manages appeals at the branch level including clinical documentation review, training, and… more
- Elevance Health (Ashburn, VA)
- …(such as LTSS/IDD), behavioral health or physical health needs. + Submits utilization /authorization requests to utilization management with documentation ... to, potential for high-risk complications). + Engages the primary service coordinator and other clinical healthcare management and interdisciplinary teams… more
- Corewell Health (Wayne, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Responsible for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning… more
- Corewell Health (Farmington Hills, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Responsible for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning… more
- Elevance Health (Des Moines, IA)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... **LTSS Service Coordinator ** _Location:_ This is a field based position....plan, engaging the member's circle of support and overall management of the individuals physical health (PH)/behavioral health (BH)/LTSS… more
- Elevance Health (Scottsburg, IN)
- …associates, and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation ... per week in-person with patients, members or providers. The **LTSS SERVICE COORDINATOR ** is responsible for conducting service coordination functions for a defined… more
- Devereux Advanced Behavioral Health (Berwyn, PA)
- …customers - Professional development and job advancement. As an admission and utilization coordinator you will ensure efficient admissions process to meet ... our Team at Devereux Advanced Behavioral Health!_ **Being an** **Admissions & Utilization Review Coordinator ** **at Devereux has its Advantages** We offer:… more
- Providence (WA)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review, Prior Authorization, Medical ... them._** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide.../ Medicaid who will:** + Provide care coordination, case management and care management services to Providence… more