- Elliot Health System (Bedford, NH)
- …an impact on quality of patient care and/or length of stay. Collaborates with case manager to assess for patient's clinical course to verify patient's continued ... collects clinical data in support of quality, risk management, utilization , infection control and resource utilization etc. Participates in multidisciplinary… 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
- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... **Overview** The Utilization Review Physician 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; ... sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral Health or infusion therapy experience + A typical… more
- Pacific Medical Centers (Renton, WA)
- …Registered Nurse License. + 5 years Clinical experience. + Utilization review / case management. **Preferred Qualifications:** + Bachelor's Degree ... to assure cost effective, appropriate utilization of health care resource. Utilization Nurse / Case Manager manages, directs, and coordinates the entire… more
- Alight (NJ)
- …health, worker compensation, disability, health case management, or utilization review . + 2+ years as a Clinical Case Manager. Additionally, ... 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
- UPMC (Pittsburgh, PA)
- …for UPMC. + Partner with department leaders in Revenue Cycle/Coding, Utilization Review / Case Management, and Clinical Analytics to design, develop, and ... Finance, Clinical Analytics, Value Based Care, and Utilization Review / Case Management to establish...Finance, Clinical Analytics, Value Based Care, and Utilization Review / Case Management, facility Quality… more
- Beth Israel Lahey Health (Burlington, MA)
- …just taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient ... the multidisciplinary team to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and med/surg… more
- Baptist Memorial (Jackson, MS)
- …+ Employee referral program Job Summary: Position: 19738 - RN- Utilization Review Facility: MBMC - Hospital Department: HS Case Mgmt Administration Corporate ... Overview Summary The Utilization Review Nurse is responsible for...against standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of… more
- AdventHealth (Altamonte Springs, FL)
- …in any field of study . Experience in denial management, utilization review , case management, clinical documentation improvement, revenue integrity, or ... have at least an Associate's Degree in Nursing) . Utilization Review / Utilization Management experience of...related field . Certification in Case Management (ACMA/CCM) . Certification Clinical Documentation… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review / case management/ clinical /or combination; ... Experience: 7 years-healthcare program management. Preferred Licenses and Certificates: Case Manager certification, clinical certification in specialty area.… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... problems to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and… more
- Lompoc Valley Medical Center (Lompoc, CA)
- …preferred. * Experience: A minimum of two years of clinical experience in Utilization Review or Case Management is preferred. * Per Diem Positions: ... experience and internal equity. Position Summary: * Reports to the Director of Case Management * Plan, organize and deliver utilization management activities for… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200415/ case -manager%2c-rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...of an accredited school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager… more
- Molina Healthcare (FL)
- … Clinical Social Worker/Counseling (or related field) License Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff....learners to understand and apply. + Creates and uses clinical case scenarios to simulate how training… more
- Trinity Health (Silver Spring, MD)
- …team to coordinate care and address clinical documentation needs for accurate case review and status determination. + Oversee the continuity of care by ... **Employment Type:** Full time **Shift:** Day Shift **Description:** **Position Purpose:** As a Case Manager in Utilization Management, you will be the key to… 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
- Prime Healthcare (Inglewood, CA)
- …leadership and supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/200257/director-of- case -management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital… more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
