- Beth Israel Lahey Health (Plymouth, MA)
- …you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR and… more
- CoreCivic (Brentwood, TN)
- …bonus eligible._ **SUMMARY:** The Manager , Utilization Management /Case Management provides Utilization Review and Case Management functions ... better the public good. CoreCivic is currently seeking a ** Manager , Health Services Audits** located at our corporate office...Collaborates with management for oversight of the utilization review process to ensure services being… more
- Beth Israel Lahey Health (Burlington, MA)
- …taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management … more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - Day ... + Posted:Today **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN...in orientation of fresh staff as requested by the Manager of Utilization Management . 17.… more
- Ascension Health (Baltimore, MD)
- …and salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing ... the areas of utilization criteria, appeal and review process, and case management system documentation....resolution to maintain smooth operations. **Registered Nurse, Certified Case Manager (CCM, ACM, URAC) preferred or willing to obtain… 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
- 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 ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or… more
- Tufts Medicine (Burlington, MA)
- …The position provides day to day support and oversight to Utilization Review departments and UM vendor management . Responsible for compliance with CMS ... Review and Discharge Planning including implementation and annual review of the Utilization Management ...the Utilization Management Committee. The Utilization Management Operations Manager follows… more
- Trinity Health (Mason City, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case ... care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to inform them of extended stay… more
- UPMC (Hanover, PA)
- **UPMC is hiring a part time Professional Care Manager for our Utilization Review department in Hanover! This is a part time, day shift position with a ... (CM) coordinates the clinical and financial plan for patients. Performs overall utilization management , resource management , discharge planning and… more
- Centene Corporation (Olympia, WA)
- …care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective ... with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations...skills including ability to use PowerPoint. · Accredited Case Manager (ACM) or Certified Public Accountant (CPA) preferred, Six… 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
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case- manager %2c-rn utilization - review ... 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
- Trinity Health (Lavonia, GA)
- …level of care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity ... **Employment Type:** Full time **Shift:** **Description:** The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and… more
- Stanford Health Care (Palo Alto, CA)
- …- 5+ years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? ... Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge… 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 ... HMO environment + Thorough knowledge of health care industry, utilization review , utilization management...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Baptist Memorial (Meridian, MS)
- …Minimum Required: RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer ... Overview RN Utilization Review Weekender Job Code: 22818...management , medical necessity reviews, verification of authorization, resource utilization , and denial prevention. Job Responsibilities + Completes and… more
- Dignity Health (Santa Cruz, CA)
- …+ _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted ... for appropriate status determination._ + _Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted… more
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