- Humana (Baton Rouge, LA)
- …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 utilizes clinical nursing skills...1 or more years previous clinical experience in a Post - Acute clinical setting such as a SNF,… more
- Sutter Health (Sacramento, CA)
- …health care and community resources A broad knowledge base of health care delivery, Post - Acute Care, Utilization Management , and case management ... SHSO-Population Health Services-Valley **Position Overview:** The RN Manager of Post - Acute Performance Management team is...operations of the Post - Acute Performance Management team to ensure cost effective utilization … more
- CVS Health (Columbus, OH)
- …state of residence + 1+ years of clinical experience in acute or post - acute setting + Utilization management is a 24/7 operation. Work schedules may ... include weekends, holidays and evening hours._ This is a full-time remote Utilization Management opportunity. As a Utilization Management Nurse… more
- Humana (Dublin, OH)
- …Qualifications** + 3 or more years' experience in acute and/or post - acute setting + Utilization Management experience a plus + Education: BSN ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing... required + Prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting + Comprehensive… more
- CVS Health (Raleigh, NC)
- …state of residence + 1+ years of clinical experience in acute or post - acute setting + Utilization management is a 24/7 operation. Work schedules will ... schedules may include weekends, holidays, and evening hours_ As a Utilization Management Nurse Consultant, you will utilize clinical skills to coordinate,… more
- CVS Health (Austin, TX)
- …+ Clinical experience in post - acute setting + Prior utilization review or case management experience + Managed Care experience **Education** ... training sessions or other events, as directed by their Leader. - Utilization Management is a 24/7 operation and the work schedule will include weekends,… 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
- Sutter Health (Sacramento, CA)
- …trending. * Directs and oversees the Case Management Assistants to determine preferences for post - acute care services. Post - Acute Care Performance ... strong, trusting, and professional working relationships to improve total post - acute cost of care and improve patient...barriers to patient care they experience with the SNFs. Utilization Management . * Reviews medical record to… 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
- The Cigna Group (Bloomfield, CT)
- …Knowledge of applicable state and federal laws, URAC and NCQA standards, and utilization management FLSA _(Exempt or Non-Exempt)_ : Exempt Bonus Type: _(Indicate ... necessity requests for clinical services that do not meet utilization review criteria and renders a clinical opinion about...review of medical necessity requests for clinical services (including post - acute care) and render a clinical opinion… more
- Alameda Health System (Oakland, CA)
- …staff at all AHS acute care facilities. 2. Communicates status with Utilization Management staff and arranges for patient transfer; functions as a key ... utilization review to ensure certification/approval of in-patient and post discharge services as delegated by the care coordination...in Utilization Management or Case Management at a Medical Group, Acute Care… more
- UNC Health Care (Raleigh, 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
- CVS Health (Austin, TX)
- …may include weekends and holidays and evening rotations._ This is a full-time remote Utilization Management Nurse Consultant opportunity. As a Utilization ... Registered Nurse + 1+ years of clinical experience in acute or post - acute setting +...residence with 6 weekends per year with rotating Holidays. Utilization management is a 24/7 operation. Work… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Management Representative (UMR) provides office support for all units within the Utilization Management and/or ... direct communication with KSC Clinic Representatives as needed. The Utilization Management Representative is responsible for clerical...and entry of bed day data and pre and post - acute certification requests for specific services. Under… more
- Beth Israel Lahey Health (Burlington, MA)
- …the healthcare team to coordinate and facilitate patient discharge. 14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post ... . 7) Works with patients and families to facilitate post hospital care and develop plans to meet short...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- CVS Health (Hartford, CT)
- …Qualifications** + Must reside within the Eastern or Central time zone + Utilization management is a 24/7 operation. Work schedules will include weekends ... external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working...step-down unit + 1+ years of clinical experience in acute or post - acute setting +… more
- Munson Healthcare (Traverse City, MI)
- …of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician… more
- Ellis Medicine (Schenectady, NY)
- Basic Function: The Utilization Management Registered Nurse (UM RN) supports daily coordination of care across healthcare continuum with the healthcare team, ... responsible for preoperative, concurrent and retrospective reviews in accordance with the utilization management program. The UM RN ensures the appropriate level… more
- CVS Health (Phoenix, AZ)
- …completed and UMNC participating in non-traditional, weekend shift rotation. As a Utilization Management Nurse Consultant you will utilize clinical experience ... external constituents in the coordination and administration of the utilization /benefit management function. - Typical office working...of residence - 1+ years of clinical experience in acute or post acute setting… more
- UPMC (Hanover, PA)
- …plan for patients. Performs overall utilization management , resource management , discharge planning and post - acute care referrals and authorizations. ... hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part...alternative/multiple discharge plans in anticipation of patient need for post - acute services. Uses InterQual criteria to justify… more