- UNC Health (Chapel Hill, NC)
- …processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per established departmental protocol. Maintain knowledge of ... is seeking a Registered Nurse (RN) Care Manager for a nursing job in Chapel...the integrating and functions of case management , utilization review and discharge planning. The Care Manager… more
- Wilson Medical Center (Wilson, NC)
- …delivery of healthcare services. The Case Manager integrates the roles of Utilization Management , Case Management , and Discharge Planning. The Case ... The Case Manager independently performs clinical reviews based on the Utilization Review Plan with follow-up actions identified for medical necessity and level… more
- UT Health Tyler (Tyler, TX)
- …treat one another with respect. Responsibilities The Manager of Case Management has overall responsibility for hospital utilization management , ... Overview Join our team as a full-time Manager of Case Management in Tyler,... and operational management of the Case Management Department to promote effective utilization of… more
- Fresenius Medical Care (Austin, TX)
- About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As ... leading your business, and advanced leadership. As a Clinical Manager , you may advance your career into an Area...of Disease (ICD) coding. Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Advocate Aurora Health (Adell, WI)
- …with status report on a regular basis.Communicates problems to physicians and management and clearly states plans, actions and goals so changes are reflected ... caseload for optimal functional and financial outcomes; reviews caseload for Low Utilization Payment Adjustments (LUPA), optimal number of visits based on progress,… more
- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... RN licensure in CA required + Bachelors of Science, Nursing (BSN) degree required + Five or more years...(BSN) degree required + Five or more years of utilization management required + Four or more… more
- Medical Mutual of Ohio (OH)
- …team members and operations of assigned commercial and government clinical care utilization management area. Evaluates team resources and production data and ... Manages operations and projects of assigned commercial and government care management area in accordance with departmental and corporate objectives.This may include… more
- Elevance Health (Washington, DC)
- …degrees of medical complexity and acuity. Participates in case and/or utilization management execution/decision making for managed member populations. Primary ... state or federal requirements that may apply is required. + Masters in related Health/ Nursing field preferred. + Certified Case Manager Certification preferred. more
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/157767/case- manager utilization - management ... in a related field or at least one year experience in case management , discharge planning or nursing management ; + CCM or obtained within 6 months of hire.… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** The Manager Utilization Management Nursing utilizes clinical nursing skills to ... documentation and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …performance/quality improvement activities that lead to optimal patient outcomes. A Case Manager differs from other roles in professional nursing /health care ... nature, level and purpose of the job. Case Managers are licensed nursing professionals responsible for coordinating continuum of care and discharge planning… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont ... more information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is...in social work, counseling or a Michigan licensed Registered Nurse is required. + Full licensure in the State… more
- Trinity Health (Fresno, CA)
- …Review of Acute Care seeking your next adventure?** **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager is responsible for ... healing mission of Saint Agnes Medical Center. The RN Manager of Utilization Management will...and hospital staff **Requirements** + State of California Registered Nurse (RN) License. + Current American Heart Association (AHA)… more
- UNC Health Care (Chapel Hill, NC)
- …communities we serve. RN Utilization Manager position specifically for a Utilization Manager /Clinical Appeals Nurse . This person is based at the ... through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to… more
- Centene Corporation (OK)
- … review clinicians to ensure appropriate care to members. Manages BH utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management ....standards **Education/Experience:** Requires Graduate of an Accredited School of Nursing or Bachelor's degree and 5+ years of related… more
- Mountains Community Hospital (Lake Arrowhead, CA)
- Full Time - Exempt position SUMMARY The Case Manager is responsible for utilization management and case management of patient admissions at MCH by ... knowledge of state and federal regulations. EDUCATION/EXPERIENCE Current California Registered Nurse License Five years nursing experience required CERTIFICATES,… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager , Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ... UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with all departments to achieve… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... American Case Management Association (ACMA); California Registered Nurse (RN) - CA Board of Registered Nursing...Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager… more
- Dignity Health (Rancho Cordova, CA)
- …home.** **Position Summary:** Under the guidance and supervision of the department Manager /Director, the Supervisor of Utilization Management is responsible ... Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management... skills. - Graduate of an accredited school of nursing . - Clear and current CA Registered Nurse… more
