- 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
- Humana (Frankfort, KY)
- …a part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for… 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 ... (BSN) degree required + Five or more years of utilization management required + Four or more...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… 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 ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Centene Corporation (Olympia, WA)
- …Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... facilitates operations within utilization management . + Manages prior authorization, concurrent review, and retrospective clinical review team and ensures… more
- Prime Healthcare (Anaheim, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/199249/case- manager 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
- Tufts Medicine (Burlington, MA)
- …with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... the Utilization Management Plan and assisting...most appropriate setting utilizing medically indicated resources. The system's utilization management model outlines a collaborative practice… 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
- Alameda Health System (Oakland, CA)
- …requirements. 16. Participate in orientation of fresh staff as requested by the Manager of Utilization Management . 17. Maintains knowledge of current ... System Utilization Management SUM Utilization ...in the State of California Preferred Licenses/Certifications: Certified Case Manager (CCM) or Accredited Case Manager (ACM)… more
- Stanford Health Care (Palo Alto, CA)
- …practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, ... an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine...evidence-based and patient-centered care. We are seeking a results-driven manager to further develop the framework for clinical, operational,… more
- Trinity Health (Chelsea, MI)
- …Type:** Part time **Shift:** Day Shift **Description:** **Registered Nurse Case Manager ** **Department:** Utilization Management **Location:** Chelsea, MI ... **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more
- Penn Medicine (Philadelphia, PA)
- …their critical thinking skills and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, ... hospice, community resources, transportation, and quality data collection and risk management referral. + Responsibilities: Utilization management … more
- Dartmouth Health (Lebanon, NH)
- …preferred, ie, Certified Professional in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), ... desired * Extensive knowledge of payer mechanisms and clinical utilization management is required. * Possesses working...Case Manager (CCM) OR Certified Accredited Case Manager (ACM) OR Case Management Administrator (CMA)… 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)
- …Health was named Long Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the...as liaison between the Utilization and Appeals Management Department and the physician of record, as required.… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Hybrid work schedule available. Monday-Friday, 8:00AM-4:30PM. + **Hospital:** Ascension St. ... salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... 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, coordinating, implementing, and finalizing projects related to Pharmacy, Medical… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... safety net required to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for executing the day-to-day operations… more
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