- CHRISTUS Health (Alamo Heights, TX)
- …for assigned areas; at CHRISTUS St. Patrick Hospital. The nurse manager affects departmental outcomes through interpretation, implementation, and evaluation of ... excellence in patient care, patient experience and patient outcomes. Effectively manages utilization of staff and material resources so that the most therapeutically… more
- CHRISTUS Health (Wake Village, TX)
- …nursing is required. Experience Minimum of two (2) years' experience in Case Management and/or Utilization Management is required. Licenses, Registrations, ... patient class when errors are identified to maximize hospital reimbursement and resource utilization . * Responsible for 24/7 ongoing management of patients in… more
- Humana (Salem, OR)
- …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
- Commonwealth Care Alliance (Boston, MA)
- …care services,procedures, and facilities under the provisions of CCA's benefits plan.The Manager , Utilization Management is responsible for overseeing and ... CMS compliance standards in the area of service decisions and organizational determinations.The Manager , Utilization Management reports to the Director of… more
- Providence (Mission Hills, CA)
- **Description** The Manager of Utilization Management provides a key role in leading, facilitating and managing the hospital utilization management ... Region. The Manager assists the Regional Director of Utilization Management , Appeals & Clinical Training through the provision of ongoing assessment… more
- Elevance Health (Tampa, FL)
- …with health plans for people enrolled in Medicaid and/or Medicare programs in Florida. ** Manager I Utilization Management ** **Location:** 11430 NW 20th ST, ... with PulsePoint sites used for collaboration, community, and connection. The ** Manager I Utilization Management ** is responsible for the daily management… more
- CVS Health (Springfield, IL)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. This position is responsible ... Registered Nurse + 3+ years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership experience (formal or informal roles)… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review, under the supervision and in collaboration with ... area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge of...trusted provider of health services within our community. A Manager at Holy Cross Hospital is expected to demonstrate… 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 ... (BSN) degree required + Five or more years of utilization management required + Four or more...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- VNS Health (Manhattan, NY)
- OverviewManages the utilization management team to ensure that standards for service delivery and team/staff performance levels are met or exceeded. This ... quality issues or complaints, and/or approvals requiring next level authorization (eg, utilization management , high cost services, out of network services,… 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)
- …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
- Elevance Health (FL)
- **JR133557 Manager II Behavioral Health Services ( Utilization Management for Behavior Analysis Services)** Responsible for Behavioral Health Utilization ... Candidate will be responsible for the oversight of the utilization management team. + Responsible for a...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… 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
- Evolent Health (Columbus, OH)
- …agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager , Intake Utilization ... Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for processing… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed… more
- Amazon (Seattle, WA)
- …them to completion. We're seeking an experienced Technical Infrastructure Program Manager to oversee data center electrical infrastructure optimization projects. You ... will lead cross-functional and technical teams identify sub-optimal utilization , determine root causes, design solutions and drive project delivery. Along the way,… more
- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... includes data collection, analysis, implementation of and compliance with risk management and claims activities, support of and participation in Continuous Quality… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager (Ohio Resident)** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 **Job Brief** ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. Under the direction of the Utilization Management , Assistant Manager , you will play a key role in processing ... role within a leading health organization. Help ensure smooth and efficient case management processes to support quality care. Take your expertise to the next level.… more
