- Sharp HealthCare (San Diego, CA)
- …of the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- Queen's Health System (Kamuela, HI)
- …and research. * Accountable for the development, organization, and implementation of utilization review (UR) processes in order to achieve efficient cost effective ... safe and effective patient care, customer satisfaction and quality outcomes. II . TYPICAL PHYSICAL DEMANDS: * Essential: standing, sitting, walking, stooping/bending,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II ...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...in the department's continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II ...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Sutter Health (Sacramento, CA)
- …SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management ( UM ) processes to support that the ... care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides third-party payers clinical information to assure… more
- Sutter Health (Salt Lake City, UT)
- …SHSO-Sutter Health System Office-Valley **Position Overview:** This position facilitates utilization management ( UM ) processes to support that the ... care delays/issues as necessary; in collaboration with the Facility Acute Care Manager (CM). This position provides third-party payers clinical information to assure… more
- Immigration and Customs Enforcement (IN)
- …this position. Responsibilities DUTIES AND RESPONSIBILITIES: Serves in the capacity of Regional Utilization Manager and subject matter expert in the oversight of ... operations in the air, on the ground and at sea. SUPERVISORY CONTROLS: The Regional Utilization Manager works under the supervision of the IHSC Utilization … more
- Hackensack Meridian Health (Hackensack, NJ)
- …and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals and clinical improvement ... **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare...formal educational lectures and engage in frequent informal meetings ii . Retrospective Medical Record Documentation Review iii. Clarifying ambiguous… more
- Elevance Health (Rocky Hill, CT)
- …insightful analytics to improve the delivery of care.** **BH Care Manager II ** Responsible for authorizing and reviewing utilization of mental health and ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...(BCBA) is also acceptable. + Previous experience in case management/ utilization management with a broad range of experience with… more
- Elevance Health (Houston, TX)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and… more
- Elevance Health (Woodland Hills, CA)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for **Applied Behavioral Analysis (ABA)** services only,… more
- Elevance Health (Rocky Hill, CT)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... Equipment (DME) forms and patient status reports.Anticipates and completes documentation needs (ie UM , Plan of Care (POC), patient status reports) prior to their due… more
- LA Care Health Plan (Los Angeles, CA)
- …member care with internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social ... and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required… more
- Elevance Health (Colorado Springs, CO)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... of the United States required. + **Previous experience in case management/ utilization management with a broad range of experience with complex psychiatric/substance… more
- LA Care Health Plan (Los Angeles, CA)
- …health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit ... Compliance Advisor II Job Category: Administrative, HR, Business Professionals Department:...Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties… more
- Houston Methodist (Nassau Bay, TX)
- …percentage, and other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...care to patients and while promoting the most cost-effective utilization of the hospital's resources. This position maintains accountability… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... to the PT Supervisor or supporting clinical specialist (PT II or PT III) for resolution in a timely...and patient status reports.Anticipates and completes documentation needs (ie UM , POCs, patient status reports) prior to their due… more
- ChenMed (Louisville, KY)
- …performance of the center, as the true dyad partner to the Center Manager /Center General Manager . Directly supervise, performance manage and train PCPs in ... Leads SH and Transforming Care Meeting (TCM) weekly, as well as supports Center Manager /Center General Manager in other center meetings. SMD partners with Center… more
- Queen's Health System (Kaunakakai, HI)
- …hospital-wide and Medical Staff Performance Improvement (PI), Utilization Management ( UM ), Infection Control (IC) and Employee Health. II . TYPICAL PHYSICAL ... setting. I. JOB SUMMARY/RESPONSIBILITIES Responsible to the Physical Therapy Manager . Provides inpatient and outpatient Physical Therapy services. Prepares all… more