- Integra Partners (Troy, MI)
- …and clinical processes + Develop and deliver comprehensive training programs for UM clinical staff on: + Writing clear and concise clinical ... educator to join our Operations Training & Development team as an Operations UM Training Specialist, specializing in Utilization Management ( UM ) processes. The… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according to ... criteria guidelines. The UAM serves as interdepartmental liaison identifying denial reasons and opportunities for improvement from both internal and external… more
- LA Care Health Plan (Los Angeles, CA)
- …and status follow-up. The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… more
- Whidbey General Hospital (Coupeville, WA)
- …review, status determination, clinical resource utilization, the discharge planning and appeal/ denial management. The RN - Care Manager serves as the ... JOB SUMMARY The RN - Care Manager is a health care professional with experience... will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care… more
- LA Care Health Plan (Los Angeles, CA)
- …regarding performance, customer service, etc. This position collects information required by clinical staff to render decisions, assists the Manager and Director ... Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- LifePoint Health (Hickory, NC)
- Job Summary Manager of Case Management in the departments activities and resources to achieve departmental and organizational objectives and will take the lead in ... outcome of care management as described in the initial UM plan with regard to resources, appropriateness of care...DCM and business of denials and enters on a denial log. 12. Fights denials by not accepting if… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission… more
- Guthrie (Sayre, PA)
- … Manager -of Case Management supports utilization management, discharge planning, denial prevention, and care coordination scope of practice within the department. ... utilizing current practice and process to achieve optimal patient, clinical , and operational outcomes in timely, coordinated, and cost-...The Manager -Case Management collaborates cooperatively with members of the interdisciplinary… more
- Alameda Health System (Oakland, CA)
- Manager , Care Management + Oakland, CA + Highland General Hospital + HGH Care Coordination + Full Time - Day + Management + Req #:38497-28187 + FTE:1 + ... tracking variances based on critical timelines. + Develops and provides statistical UM information and reports to appropriate committees and in conjunction with the… more
- LA Care Health Plan (Los Angeles, CA)
- …interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- Sanofi Group (Dallas, TX)
- …delays for patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical Documentation, and Peer to Peer ... **Job Title:** Transplant Field Reimbursement Manager , South Central - US **Location:** Dallas, TX...requires dedicated and knowledgeable customer facing support. Field Reimbursement Manager for REZUROCK. This is a regionally aligned, field-based… more
- Dignity Health (Redwood City, CA)
- …is required. Preferred + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred **Required Minimum Knowledge, Skills, ... staff utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement … more
- Hackensack Meridian Health (Hackensack, NJ)
- …support in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals clinical improvement objectives f. Interfaces with ... and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack University...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more
- Hackensack Meridian Health (Hackensack, NJ)
- …in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals and clinical improvement objectives d. Interfaces with ... and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack UMC....documentation e. Target DRGs Reviews f. Use of case manager as a resource + Uses guidelines to evaluate… more
- Providence (Mission Hills, CA)
- …and for overseeing the day-to-day operations of the Claims Processing and UM Denial Letter Units. Additional responsibilities include reporting functions to ... **Description** Working under the direction of the Manager , Claims, this position has direct responsible for...more. Learn more at providence.jobs/benefits. **About the Team** Providence Clinical Network (PCN) is a service line within Providence… more