- Humana (Des Moines, IA)
- …require interpretation and independent determination of the appropriate courses of action. The Post - Acute Utilization Management Nurse 2: + Review ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing...required, with no disciplinary action + 2+ years of Post - Acute clinical experience in a SNF, LTACH… more
- Sutter Health (Berkeley, CA)
- …change. This position coordinates the utilization management , resource management , discharge planning, post - acute care referrals and care ... interview patient/family and determine preferences for post - acute care services. Utilization Management . * Completes initial InterQual review screening… more
- Sutter Health (San Francisco, CA)
- …oversees the Case Management Assistants to determine preferences for post - acute care services. Utilization Management . * Reviews medical record to ... communicates to patient/family prior to transition. * Assures necessary paperwork for post - acute transfers to comply with state and federal regulatory… more
- ChenMed (Houston, TX)
- …Assists and coordinates, in conjunction with the transitional care team; hospital, SNF, post - acute , delegated utilization management and home-based ... Director/Manager, Center Managers, external sub-specialists and providers in hospitals and post - acute care facilities. **KNOWLEDGE, SKILLS AND ABILITIES:** +… more
- Insight Global (Philadelphia, PA)
- …to work from home 3+ years of case management and utilization management experience Post acute Care experience Discharge planning and post ... Management when indicated. Efficiently collaborates with the hospital utilization review department, attending physicians and members/families as appropriate. We… more
- Trinity Health (Des Moines, IA)
- …member of Mercy One's PHSO Care Management department, the Manager of Post Acute and Transition Care management provides leadership in understanding, ... management program. The incumbent is accountable for the management of all PHSO Post - Acute ...PHSO strategies and infrastructure necessary to effectively manage costs, utilization and quality associated with risk contracts in the… more
- HCA Healthcare (Asheville, NC)
- …prevent readmissions, and lower total cost of care thru the appropriate utilization of Post - Acute services.** **Qualifications:** **Required Education: ... environment where diversity and inclusion thrive? Submit your application for our Post Acute Transition Specialist CarePartners opening with CarePartners today… more
- Ascension Health (Baltimore, MD)
- …Services at Ascension Saint Agnes Hospital is responsible for overseeing the integration and management of Post Acute Care, Palliative Care, and Transitional ... treatment planning and core measures, Discharge Planning, tracking of the post - acute period and provision of disease management , and contracting internally… more
- Fresenius Medical Center (Lawrence, MA)
- …of the Fresenius' portfolio of products. + Work collaboratively with Senior Director of Post - Acute Commercial Operations team and Post - Acute National ... to ensure teamwork and proper allocation of nursing resources. + Work with Post - Acute National Account Manager(s) to improve and maintain center and patient… more
- WellSpan Health (York, PA)
- …Full Time General Summary Supervises and oversees the operations of the utilization management department. Works with hospital, regional, medical group, ... Population Health, post - acute services, revenue services and system leadership...IT, Finance, and Regulatory Affairs to enhance WellSpan Health's utilization management capabilities and execution through the… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... ensure appropriate patient status and assists with repatriation and post -stabilization reviews for patients before the patient is bedded,...Degree in a health related field. + 3 Years Utilization Management or case management … more
- Dignity Health (Northridge, CA)
- …400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing ... and collaboration with nursing physicians therapy services insurers and post acute service providers to pace the...+ Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs daily medical necessity reviews. ... with or without notice. Primary Responsibilities + Performs concurrent utilization reviews ( Acute , SNF, LTACH, ARF) and...care appropriate for the members needs, acuity and determine post - acute needs of member including levels of… more
- CVS Health (Trenton, NJ)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...Registered Nurse + 1+ years of clinical experience in acute or post - acute setting +… more
- CVS Health (Jefferson City, MO)
- …personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Nurse Consultant opportunity. Utilization ... external constituents in the coordination and administration of the utilization /benefit management function. * Typical office working...Registered Nurse + 1+ years of clinical experience in acute or post - acute setting +… more
- LA Care Health Plan (Los Angeles, CA)
- …varied clinical experience in an acute hospital setting. At least 2 years Utilization Management /Case Management experience in a hospital or HMO setting ... Utilization Management Nurse Specialist RN II...and Physician Advisor on case reviews for pre-service, concurrent, post -service and retrospective claims medical review. Monitors and oversees… more
- UPMC (Harrisburg, PA)
- …with all state, federal and regulatory agencies. Serve as the coordinator in utilization and report generation from the EPIC system. Create and manage the operating ... agreements for BU. Provide direction and support to the BU management staff for clinical purchasing (pharmaceuticals, laboratory supplies, med-surgical supplies,… more
- Geisinger (Lewistown, PA)
- …and handling of equipment. + Participates in unit-based decision-making regarding the utilization of evidence- based practice. + Actively participates as a team ... vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and… more
- UNC Health Care (Rocky Mount, NC)
- …hospital, continued stay, and use of other hospital services in accordance with Utilization Management Plan, Conditions of participation (CoP) and other federal ... throughput from hospital admission through discharge and to the appropriate post - acute setting. **Responsibilities:** 1. Constantly maintains an environment of… more
- UNC Health Care (Smithfield, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... and payors), and assesses the patient care progression from acute care episode through post discharge for...management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization… more