- A-Line Staffing Solutions (Shaker Heights, OH)
- …, Certified Case Manager , Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Waiver Program, Registered Nurse, MCO, ... InterQual, ICD-10, URAC, CMS, Medicare , Medicaid, Case Management , Certified Case Manager , Medical Coding, BSN,...Manager , Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered… more
- A-Line Staffing Solutions (Mcallen, TX)
- …BSN, MSN, ADN, Case Manager , Utilization Manager , UR, UM, Utilization Review, Case Management , Medicare , Medicaid, CMS, URAC, Rx, CCM, Home ... , Utilization Manager , UR, UM, Utilization Review, Case Management , Medicare ,..., Utilization Manager , UR, UM, Utilization Review, Case Management , Medicare ,… more
- Aveanna Healthcare (Worcester, MA)
- … Driving EVV Utilization Driving Electronic documentation (EMR) utilization Compliance tracking Unemployment claim management Worker compensation ... The Operations Manager is directly responsible for the administrative functions...Driving EVV Utilization Driving Electronic documentation (EMR) utilization Compliance tracking Unemployment claim management Worker… more
- A-Line Staffing Solutions (Houston, TX)
- …Vocational Nurse, Clinical Care, Case Manager , Case Management , Utilization Review, Utilization Management , LPN, ADN, Clinical Service, Clinical ... trends and sub-standard care delivery and will report these findings back to manager Collaborate with internal care management peers and other disciplines within… more
- MetroPlus (New York, NY)
- …in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management . One-year HARP experience preferred. Field based Case ... not limited to, New York State Medicaid Managed Care, Medicare , Child Health Plus, Exchange, Partnership in Care, MetroPlus...and other resources to assist in goal achievement. Conduct Utilization Review for designated Case Management members… more
- A-Line Staffing Solutions (Tampa, FL)
- …, Certified Case Manager , Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse, MCO, RN, HMO, ... Public Admin, Social Science, Social Work, Sociology) 2+ years of Care Management experience Experience with electronic medical health records, and Microsoft office… more
- A-Line Staffing Solutions (Haverhill, FL)
- …, Certified Case Manager , Medical Coding, BSN, Medical Management , Utilization Review, Utilization Management , Registered Nurse, MCO, RN, HMO, ... Public Admin, Social Science, Social Work, Sociology) 2+ years of Care Management experience Experience with electronic medical health records, and Microsoft office… more
- Hired by Matrix (Los Angeles, CA)
- …times. Attend and participate in facility meetings as directed by Center Manager (may include utilization review, infection control, disaster preparedness, ... Develops treatment plans, supervises assistants and aides, contributes to case management , and provides quality patient care. Maintains positive level of interaction… more
- Option Care Health (Cincinnati, OH)
- …revenue, margin, and referral growth. Plays an active role in account management and business development efforts with team, engaging customers and both modeling ... opportunities tocoach and provide developmental feedback.Maintain strong relationships with branch management to ensure sales efforts are supported by branch service… more
- A-Line Staffing Solutions (San Antonio, TX)
- …, Medicaid, Discharge Planning, Determination Review, Clinical Review, DSNP, Risk Assessment, Utilization Management , Utilization Review, Managed Care, MCO, ... Fair Hearings as needed. Dental, nursing, vision, verify service utilization , hearing, 90-day MHM, 28 day follow ups; verify...Health Insurance, Health Plan, Managed Care, Care Manager , Queue Management , Case Management ,… more
- A-Line Staffing Solutions (Killeen, TX)
- …, Medicaid, Discharge Planning, Determination Review, Clinical Review, DSNP, Risk Assessment, Utilization Management , Utilization Review, Managed Care, MCO, ... Health Insurance, Health Plan, Managed Care, Care Manager , Queue Management , Case Management , Medications, Insurance Verification, Pharmacy, Prior… more
- A-Line Staffing Solutions (Mcallen, TX)
- …, Medicaid, Discharge Planning, Determination Review, Clinical Review, DSNP, Risk Assessment, Utilization Management , Utilization Review, Managed Care, MCO, ... Health Insurance, Health Plan, Managed Care, Care Manager , Queue Management , Case Management , Medications, Insurance Verification, Pharmacy, Prior… more
- A-Line Staffing Solutions (San Antonio, TX)
- …Keywords: Care Coordinator, Care Coordination, Discharge Planning, Admission Planning, CMS, Utilization Review, Utilization Management , Home Health, Home ... Healthcare, Managed Care, MCO, Case Manager , Case Management , Care Manager , Care Management , Medical Management , Community Health, Referrals, LVN,… more
- Kaiser Permanente (Roseville, CA)
- … and Medi-Cal benefits to specific patient situations.Participates in Utilization Management /Quality Assurance activities.Assist in coordinating communication ... to the patients illness. Under general direction of the Social Work Manager /LCSW, delivers age-appropriate social work care to patients and their caregivers in… more
- UCLA Health (Los Angeles, CA)
- …You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Trinity Health (Darby, PA)
- …with the RN Care Coordination Manager , provides support to the utilization management , denials and appeals process for the THMA South hospitals. ... support to the Emergency Department Case Manager , Utilization RNs, and Utilization Management ...external managed care (IBC, Aetna, etc.) and regulatory organizations ( Medicare , Medicaid, etc.) when necessary + Ensures appropriate flow… more
- Centene Corporation (IN)
- … Medicare Operations, Clinical, Pharmacy, Call Center, Provider Data, Utilization Management , Case Management , Data Analytics.:** ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- CareFirst (Baltimore, MD)
- …in the Medicare Advantage Bid process annually, the cost and utilization of all benefits to make adjustments annually, impact of marketing, sales, and ... (strategy, design, execution, and optimization) for products and plans in the Medicare , Medicaid, and Federal Employee Health Benefits categories. Leads the team in… more
- Providence (Beaverton, OR)
- …the best people, we must empower them._** **Providence Health Plan is calling a Manager Utilization Management RN, Prior Authorization who will:** + Be ... for Management and supervision of the PHP Utilization Management (UM) or Care Management...Acceleration Process (CAP) experience + Experience with HEDIS, CAHPS, Medicare 5-Star Rating, NCQA and/or URAC accreditation **Why Join… more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …+ Comprehensive knowledge of utilization management , financial management that includes revenue cycle, Medicare , Medicaid, and commercial admission ... annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the market(s)… more
