- VNS Health (Manhattan, NY)
- …understanding of the community's needs.Oversees the implementation and monitoring of utilization review and quality management procedures, while also conducting ... service delivery. Executes strategies with aim to improve member outcomes and operational efficiency. Continuously develop, implements, monitors, and assesses… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... medical records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to… more
- Trinity Health (Silver Spring, MD)
- …physician advisor and external review organizations to ensure quality outcomes , patient throughput, and appropriate resource utilization while supporting the ... Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment...RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with… more
- Hartford HealthCare (Torrington, CT)
- …*your moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- Elevance Health (Topeka, KS)
- ** Manager of Utilization Review - Kansas** **Location:** This position will work a hybrid model (remote and office). Must reside in Kansas and within 50 ... commute of a Kansas Elevance Health location (Olathe, Kansas City, or Topeka). The ** Manager of Utilization Review ** is responsible for managing a team… more
- Trinity Health (Mason City, IA)
- …**Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, ... commercial payer specific guidelines to prevent denials and revenue loss. Patient outcomes are achieved through effective application of care plans, managed care… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, concurrent,… more
- VHC Health (Arlington, VA)
- Case Manager ( Utilization Review ) Job Description Purpose & Scope: The Case Manager is responsible for the collaborative process of assessment, planning, ... health needs through communication and available resources to promote quality cost-effective outcomes . Additionally, the Case Manager ensures that identified and… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/171837/case- manager %2c-rn utilization - review ... to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent … more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... planners regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed review … more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days - 2406003414 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... cost and quality to assure optimal clinical and financial outcomes Completes admission reviews for all payors and sending...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Elevance Health (Norfolk, VA)
- **Licensed Utilization Review II** **Location** : KS, FL. and VA. This is a remote position The ideal candidate will live within 50 miles Elevance Health ... Monday through Friday,10:30 - 7:00 Eastern time** The **Licensed Utilization Review II** responsible for working primarily...and internal and external customers to help improve health outcomes for members. + Applies clinical knowledge to work… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION REVIEW + Reviews prospectively, concurrently and retrospectively… more
- UNC Health Care (Smithfield, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- Elevance Health (Tampa, FL)
- **Licensed Utilization Review Senior** _Location:_ While remote, candidate should reside within 50 miles of either Tampa or Miami, FL. The **Licensed ... Utilization Review Senior** is responsible for working...and internal and external customers to help improve health outcomes for members. + Applies clinical knowledge to work… more
- Huron Consulting Group (Chicago, IL)
- …Healthcare's providers, patients, and insurance companies to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management ... on established criteria and guidelines. + Maintain accurate and detailed records of review decisions and interactions in the utilization management system. +… more
- AdventHealth (Altamonte Springs, FL)
- …will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes . The Senior Manager of Utilization will provide support, ... **Senior Manager of Utilization ** **-AdventHealth Well65** **All...Develops and implements case management programs and education, including utilization review , transitions of care, disease management,… more
- ERP International (Corpus Christi, TX)
- **Overview** ERP International is seeking a **Registered Nurse (RN)** ** Utilization Manager ** for a full-time position in support of the **Naval Health Clinic ... range of utilization management services including referrals, care coordination, utilization review , discharge planning, continued stay reviews, and appeal… more
- Molina Healthcare (NV)
- …performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... **JOB TITLE : Manager , Healthcare Services** **This position supports our NEVADA...this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management… more
