- Sutter Health (Modesto, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… more
- Sutter Health (Burlingame, CA)
- …the acute care patient experience. This position works in collaboration with the Physician , Utilization Manager , Medical Social Worker and bedside RN ... the achievement of optimal health, access to care, and appropriate utilization of resources balanced with the patients' self -determination while coordinating… 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 ... queries from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record,… 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 We ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you...causes of denials for discussion with the internal team, physician advisor and the Utilization Review Committee… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Houston Methodist (The Woodlands, TX)
- At Houston Methodist, the Case Manager PRN (CM) position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient ... improvements, patient satisfaction). **PEOPLE ESSENTIAL FUNCTIONS** + Collaborates with the physician and all members of the interprofessional health care team to… 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 rotating ... weekend and holiday schedule.** **Purpose:** The Care Manager (CM) coordinates the clinical and financial plan for patients. Performs overall utilization … more
- Tenet Healthcare (Detroit, MI)
- …outcomes Utilizes data to provide timely and meaningful information to the Utilization Management Committee and physician staff for performance improvement. ... Group Utilization Review Director - 2506000536 Description : The...with judicious resource management Oversees submission of cases to Physician Advisor to ensure timely referral, follow up and… more
- Catholic Health Services (Melville, NY)
- …for services and coordinates utilization /appeals management review. | Assist Utilization and Appeals Manager in setting up communications with payors ... as a liaison between patient account services, physicians, care coordinators, Utilization and Appeals Managers, physician advisors and facility departments.… 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 trends and ... System Utilization Management SUM Utilization Review RN...observation, outpatient). 3. Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not… more
- Hackensack Meridian Health (North Bergen, NJ)
- …healthcare and serve as a leader of positive change. The **Care Coordinator, Utilization Management** is a member of the healthcare team and is responsible for ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay,… more
- LA Care Health Plan (Los Angeles, CA)
- …to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, post-service ... Utilization Management Nurse Specialist RN II Job Category:...cases and reports are maintained and referred to the Physician Advisor/UM Director. Document in platform/system of record. Utilize… more
- Dignity Health (Santa Cruz, CA)
- …admission status and continued hospitalization. Works in collaboration with the attending physician , consultants, second level physician reviewer and the Care ... + _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Baptist Memorial (Meridian, MS)
- Overview RN Utilization Review Weekender Job Code: 22818 FLSA Status Job Family: NURSING Job Description Title: RN Utilization Review Weekender Job Summary The ... and appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies… more
- Dignity Health (Gilbert, AZ)
- …of the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Dignity Health (Santa Maria, CA)
- …admission status and continued hospitalization. Work collaboration with the attending physician , consultants, second level physician reviewer and the Care ... and Training** * Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used * Proficient in application of clinical guidelines… more
- Hackensack Meridian Health (Maywood, NJ)
- …healthcare and serve as a leader of positive change. The **Registered Nurse Care Manager ** is a member of the healthcare team and is responsible for coordinating, ... and handoff between acute & post-acute services. RN Case Manager is for Child and Adolescent Outpatient Behavioral Health...and develop an individualized plan in collaboration with the physician and other members of the health care team.… more
- Mount Sinai Health System (New York, NY)
- **Job Description** **Job Title - Advanced Practitioner Provider Manager (Nurse Practitioner/ Physician Assistant) - Ambulatory Oncology - Mount Sinai ... Hospital-Full Time- Day** The Advanced Practice Provider Manager -Nursing is responsible for coordination, and assurance of comprehensive health care using advanced… more
- Beth Israel Lahey Health (Plymouth, MA)
- …improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding cases that do not meet ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Houston Methodist (Cypress, TX)
- At Houston Methodist, the Senior Practice Manager position is responsible for independently managing and/or coordinating complex delivery of care within a large, ... multi- physician primary care, specialty, or multi-disciplinary practice. This position...through efficient, effective and compliant procedure. The Senior Practice Manager position works collaboratively with clinic medical staff and… more