- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …services. Discover more about us at www.amerihealthcaritas.com. Join a mission-driven Utilization Management team where your clinical expertise helps shape ... experience in ICU, ED, Med-Surg, pediatrics, behavioral health, or similar. Prior Utilization Management or managed care experience preferred. Strong analytical,… more
- UHS (Bethlehem, PA)
- …for seniors, adults and adolescents. Hanover is seeking an experienced Director of Utilization Management and Review. This is a fantastic opportunity to join ... Master Degree Required 5-8 year of experience Required of Utilization Review and Management Pennsylvania RN License or LMHC/LCSW preferred EEO Statement: All… more
- Boston Childrens Hospital (Boston, MA)
- …preferred. Experience as a Case Manager (Discharge Planning and or Utilization Management ) preferred. Licensure/ Certifications: Current Massachusetts license as ... of payer denials. They identify and implement initiatives to manage utilization trends, collaborating with the hospital's discharge planning case managers,… more
- American Traveler (Salem, MA)
- …*BLS certification through AHA required, *ACLS certification through AHA required, *Case Management , Utilization Management , and Discharge Planning skill set ... American Traveler is hiring an experienced RN Case Manager with strong case management and discharge planning skills for a dayshift inpatient role. Job Details *Work… more
- Sanford Health (Bemidji, MN)
- …minimum of five years of clinical practice. Knowledge and experience in case management , utilization management and/or Coding highly preferred. Currently ... written/verbal communication, critical thinking, creative problem solving, and conflict management skills. Must be proficient in organization and planning. Must… more
- Alameda Health System (Oakland, CA)
- SUMMARY: The System Utilization Management [SUM] Utilization Review RN is responsible for ensuring the appropriate use of healthcare resources while ... in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current trends and changes in healthcare delivery… more
- HEALTH FIRST CAREERS (Melbourne, FL)
- …reimbursement analysts as necessary. Is an active member of the Utilization Management Committee. Work Experience MINIMUM QUALIFICATIONS Education: Associate's ... Emergency Department Nursing Knowledge/Skills/Abilities: Current working knowledge of care transitions, utilization management , case management and managed… more
- Medical Solutions (Omaha, NE)
- …Barbara, CA is seeking its next amazing RN (Registered Nurse) to work in Case Management ( Utilization Review). Read on if this sounds like your perfect fit! ... Nurses and allied healthcare professionals are in high demand nationwide, and our team of industry-leading, traveler-favorite recruiters can get you where you want to go - personally and professionally. Wherever you may roam, travel healthcare helps you hone… more
- Kaiser Permanente (Los Angeles, CA)
- …the interdisciplinary approach to providing continuity of care, including Utilization management , Transfer coordination, Discharge planning, and obtaining ... B21|AFSCME|SCNSC Job Level: Individual Contributor Department: Sunset Medical Center - Utilization Management - 0801 Pay Range: $60.79 - $74.4 / hour Travel:… more
- Kaiser Permanente (Sacramento, CA)
- …assigned areas. Essential Responsibilities: Assists in the coordination of the quality management / utilization management department activities. Acts as a ... consultant for appropriate departments on quality management , utilization management and risk management activities. Assists with quality management … more
- Aequor (Tampa, FL)
- …payments annual estimations. Prepare and supervise tax cost center spending, PO utilization for LATAM Region. SharePoint Management and Coordination Supervise ... to provide examples of successful cross-functional collaborations and effective management of pressure situations. Elaboration of tax provisions for deferred… more
- EvergreenHealth (Kirkland, WA)
- …arrange for equipment, and arrange for additional services in the community. Utilization Management /Case Management Nurses provide clinical information to ... illness and level of service provision. Job Summary Working under department management , specializes in assessing hospital admissions for status per defined criteria… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …certification (CCM, ACM, CCM-RN) preferred. Proven leadership experience in acute care, utilization review, case management . Strong working knowledge of hospital ... Position Summary Lead and oversee the hospital's case management department, ensuring patients receive high-quality, efficient, and coordinated care from admission… more
- Valley Health System (Paramus, NJ)
- …and Commercial payors guidelines. Monitors and intervenes on LOS, resource utilization and denial management / prevention within the assigned caseload. ... cents experience in clinical nursing, minimum of 3 years in case management / utilization . SPECIAL SKILLS: Registered Nurse, Licensed in State of New Jersey,… more
- Twist BioScience (South San Francisco, CA)
- …adherence to GxP standards, and delivery of services. Optimize the utilization of internal development resources.Budget Management : Develop and manage ... and robust data integrity within a highly automated environment. The effective utilization and continuous enhancement of our proprietary MES technologies will ensure… more
- Merck & Co. (Boston, MA)
- …addition, the candidate will leverage data to drive resource utilization and maintain up-to-date awareness of literature-related copyright compliance, vendor ... Growth Mindset, Information Retrieval, Inquiry Handling, Interpersonal Relationships, Knowledge Management , Library Management , Library Services, Life Science,… more
- Curative HR LLC (Austin, TX)
- …teams, including Nurse Practitioners, Care Coordinators, and Operations, to optimize utilization management processes and improve member outcomes. Contribute to ... development, review, and revision of medical policies, clinical guidelines, and utilization management protocols. Participate in quality improvement initiatives,… more
- Northwell Health (New York, NY)
- …or throughout the entire continuum of health care delivery. Performs resource management , utilization management , discharge planning, care facilitation, ... duties with a defined patient population, and as it relates to care management and the delivery of patient care services. Communicates with payers addresses and… more
- Tenet Health (Nacogdoches, TX)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention; Transition ... This position may qualify for a sign-on bonus Summary Responsible for hospital utilization performance improvement and operational management of the Case … more
- NorthShore (Arlington Heights, IL)
- …Management Program is responsible for the case management , care coordination management , and utilization management of his/her population of patients ... for appropriate consultations and support services within established protocols Completes Utilization Management for assigned patients. Applies Milliman Care… more
