- Centene Corporation (Madison, WI)
- …care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review, and retrospective ... with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- InnovaCare (San Juan, PR)
- …Inpatient days, documents, and codes and reports the data to the Utilization Management Inpatient Coordinator and Inpatient Nurses.13. Captures required in ... patient utilization data and forwards the information, daily, to the Utilization Management Inpatient Coordinator.14. Prepares and submits to the Health… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... knowledge of health care industry, utilization review, utilization management , and concurrent review...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Guidelines (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) -… more
- Cleveland Clinic (Vero Beach, FL)
- … Manager . May design and initiate special projects as supervised by the Team Manager . Utilization Management Specialist Join our team at Cleveland Clinic ... Under the general supervision of the UM Team Manager , this individual performs UM activities which includes...of the most respected healthcare organizations in the world. Utilization Management (UM) Specialists perform UM activities,… more
- Sharp HealthCare (San Diego, CA)
- …Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American ... (RN) - CA Board of Registered Nursing; Accredited Case Manager (ACM) - American Case Management Association...in Healthcare or a related field + 3 Years Utilization Management or case management … more
- ERP International (Nellis AFB, NV)
- …No Call, No Weekends, No Holidays! **Job Specific Position Duties:** * Provides Utilization Management activities and functions by using MTF specific Quality ... management disciplines to include discharge planning and referrals for case management . * Utilization management duties incorporate discharge planning to… 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 ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- Sutter Health (Sacramento, CA)
- …**Organization:** SHSO-Population Health Services-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that ... timely movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care… more
- Hackensack Meridian Health (Hackensack, NJ)
- … Criteria ( ie MCG, Xsolis) b. Supports & Participates in pre-admission review, utilization management , and concurrent and retrospective review process. c. ... direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Hackensack Meridian Health (Hackensack, NJ)
- …( ie MCG,** **Xsolis)** **b. Supports & Participates in pre-admission review, utilization management , and concurrent and** **retrospective review process.** ... - OBS vs. Inpatient** **c. Liaison to the Medical Staff supporting Utilization Management Committee processes** **d. Hospital Based Appeals Management… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/180750/case- manager -rn utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/181372/case- manager -%28rn%29 utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Healthfirst (NY)
- **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification performing risk-identification, ... preadmission, concurrent , and retrospective reviews to evaluate the appropriateness and...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Trinity Health (Pontiac, MI)
- …customers and community groups. **D.** **Experience** Three years recent acute care utilization management experience. Knowledge of regulations relative to ... RN licensure within the State of Michigan. Certified Professional in Utilization Review/ Management preferred. **C** **Special Skill / Aptitudes** Understanding… more
- McLaren Health Care (Detroit, MI)
- …setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and ... **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …transform healthcare and serve as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding of behavioral ... level of care setting for continued treatment. Employs the utilization management process to assist in setting...regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at… more
- Hackensack Meridian Health (Neptune, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more