- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor sources. Identifies… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, and ... **Overview** **The Utilization Review Physician collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization ** **Management & Clinical documentation.** **b. Oversight… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... **Overview** The Senior Utilization Review Specialist collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Prime Healthcare (Ontario, CA)
- …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + An ... strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with facility-based case … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review / case management/ clinical /or combination; ... independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… more
- WellSpan Health (York, PA)
- …CM leadership team in developing and maintaining CM policy including, Utilization Review , Social Services and Clinical Case Management. + Identifies ... telephonic liaison staff) and the function of precert, concurrent review and denial management. + Acts as a resource...(BSN) Required Work Experience: + 2 years Experience in Case Management, Utilization Management, or clinical… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review / case management/ clinical /or combination; ... like in this role: Employee will be providing telephonic case management for our members. + Past job instability....nurses MUST have 4 years or more of RECENT clinical experience. + Strong communication skills required to provide… more
- Alight (NJ)
- …occupational health, worker compensation, disability, health case management, or utilization review . + 2+ years as a Clinical Case Manager + ... careers.alight.com (https://careers.alight.com/us/en) . **About the Role** This role will provide clinical expertise and serve as a critical link between all parties… more
- Trinity Health (Silver Spring, MD)
- …management/supervision/leadership experience in an acute healthcare setting required, preferably with case management, utilization review or closely related ... **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge… more
- Covenant Health (Nashua, NH)
- …and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory ... team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to...five years broad clinical experience preferred + Case management and/or Utilization Management experience is… more
- Baptist Memorial (Jackson, MS)
- …+ Employee referral program Job Summary: Position: 19738 - RN- Utilization Review Facility: MBMC - Hospital Department: HS Case Mgmt Administration Corporate ... Summary The Utilization Review Nurse is responsible for...against standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of… more
- Trinity Health (Mason City, IA)
- …its goals **Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case ... resource management, knowledge of community resources, and collaboration with other clinical disciplines. **What We Are Looking For** Education [formal]: + Licensed… more
- Sharp HealthCare (San Diego, CA)
- …patient care areas. This position requires the ability to combine clinical /quality considerations with regulatory/financial/ utilization review demands to ... clinical needs with the efficient and cost effective utilization of resources while promoting quality outcomes. **Required Qualifications**... case management experience + 3 Years recent case management, utilization review , care… more
- Stanford Health Care (Palo Alto, CA)
- … management principles. + Experience in case management, utilization review , or related healthcare roles. + Strong clinical assessment and critical ... ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization ...Review medical records to ensure complete and accurate clinical documentation to support medical necessity. + Stay current… more
- UNC Health Care (Raleigh, NC)
- …base tasks, or other electronic communication and via telephone. Responsibilities: 1. Clinical Review Process - Uses approved criteria and conducts admission ... **Description** **Full time exempt, 40 hours per week Utilization Manager - Medical necessity review ...through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical … more
- Kepro (Chicago, IL)
- …+ Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams within the clinical domain of case review ... years of Case Management and/or Utilization Review experience. + Knowledge of clinical aspects of nursing/ case management/ utilization review… more
- Helio Health Inc. (Syracuse, NY)
- … review , and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our Inpatient, ... referring to the medical provider those that require additional expertise. + Review clinical information for concurrent reviews, extending the length of… more
- Mount Sinai Health System (New York, NY)
- **Job Description** ** Utilization Management Specialist MSH Case Management FT Days** This position is responsible for coordinating requests for clinical ... internal and external to the institution. Position responsibilities will include utilization management support functions for patient admissions and continuing stay.… more
- Billings Clinic (Billings, MT)
- …/ Management RN. This position is to conduct initial, concurrent, retrospective chart review for clinical financial resource utilization . Coordinates with ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… more
- Hackensack Meridian Health (Belle Mead, NJ)
- … of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and ... the care for a designated patient caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse, and other members of the treatment team,… more