- Centene Corporation (Olympia, WA)
- …5+ years of related experience. + 2+ years supervisory experience preferred. + Knowledge of utilization management principles preferred. + Prior ... Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and… more
- Humana (Frankfort, KY)
- …and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge , communication skills, and independent ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...in utilization management and appeal/denial management . + Holds a strong working knowledge … more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management , utilization review, social work, care coordination and discharge planning. + ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… 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 ... + Thorough knowledge of health care industry, utilization review, utilization management , and...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- CoreCivic (Brentwood, TN)
- …position will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager , Utilization Management /Case Management provides Utilization ... standards, and government laws and regulations. + Manages a team of utilization management nurses.Provides direction and supports staff in the development… more
- Beth Israel Lahey Health (Burlington, MA)
- …of three years of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management experience, and… more
- Helio Health Inc. (Syracuse, NY)
- …to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting our ... Educate program staff on current principles and standards of practice surrounding utilization and denials management . + Use effective relationship management… more
- Catholic Health Services (Melville, NY)
- …with industry standards and business objectives related to Utilization and Care Management as appropriate. Sound knowledge and skill in the use of personal ... Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/205657/case- manager pvh- utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/199249/case- manager utilization - management ... or management , preferred. + Current BCLS certificate preferred. + Knowledge of Milliman Criteria and InterQual Criteria preferred. West Anaheim Medical Center… more
- Alameda Health System (Oakland, CA)
- …Participate in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current trends and changes in ... System Utilization Management SUM Utilization ...in the State of California Preferred Licenses/Certifications: Certified Case Manager (CCM) or Accredited Case Manager (ACM)… more
- Houston Methodist (The Woodlands, TX)
- …requirements/issues, and eligibility for state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case ... At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered...licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated… more
- Gentiva (Mooresville, NC)
- …a lasting difference in people's lives every day. **Overview** We're looking for a ** Utilization Manager ** to join our team. This position will directly report ... to the Director of Utilization Management and is responsible for planning,...+ Professional presentation experience and proficient communication skills + Knowledge of hospice rules, regulations, policies and Conditions of… more
- Trinity Health (Mason City, IA)
- …+ Works directly with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to ... Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case screening, insurance… 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 ... to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- LA Care Health Plan (Los Angeles, CA)
- … Knowledge of state, federal and regulatory requirements in Care/Case/ Utilization Management . Strong verbal and written communication skills. Computer ... Supervisor, Utilization Management RN Job Category: Clinical...Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager /Director… more
- UPMC (Hanover, PA)
- …(CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and ... **UPMC is hiring a part time Professional Care Manager for our Utilization Review department...Management Training sessions in order to maintain current knowledge of all payer and regulatory requirements, UPMC CM… more
- LA Care Health Plan (Los Angeles, CA)
- … of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or Care Management (CM). Knowledge of Department of Health ... Utilization Management Nurse Specialist RN II...implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …of physicians and nurses working with the Rady Children's Health Network. The Utilization Management Medical Director will collaborate closely with the clinical ... care and quality. The ideal candidate will have a strong pediatric clinical background. Utilization management experience is a plus. This position is part time… more
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