- WellSpan Health (York, PA)
- Utilization Management Nurse (RN) - Case Management - Day (Temporar Location: WellSpan Health, York, PA Schedule: Full Time Schedule Temporary Role ... WellSpan's geographic footprint. General Summary Performs a variety of reviews and applies utilization and case management techniques to determine the most… more
- CoreCivic (Brentwood, TN)
- …a responsibility to better the public good. CoreCivic is currently seeking a **Manager, Utilization Management / Case Management ** located at our ... $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager, Utilization Management / Case Management ...the information to facilitate process improvement. + Domestic US travel may be required. **QUALIFICATIONS:** + Graduate from an… more
- Excellus BlueCross BlueShield (Utica, NY)
- …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- McLaren Health Care (Detroit, MI)
- …degree in coding/medical records/billing or healthcare related field + Two years of case management or utilization review, billing, or coding experience ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more
- UCLA Health (Los Angeles, CA)
- …can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a team of UM ... (BSN) degree required + Five or more years of utilization management required + Four or more...complex federal and private insurance regulations + Ability to travel /attend off-site meetings and conferences + ACM - Accredited… more
- Catholic Health (Buffalo, NY)
- …hospital and community or obtained within 6 months + National Certification in Case Management preferred EXPERIENCE + Two (2) years medical surgical nursing ... Review, as an active member of the Care Management and interdisciplinary care team, provides comprehensive Utilization...utilization review experience in the role of a Case Manager or Disease Manager, Population Health, Discharge Planning… more
- UTMB Health (Friendswood, TX)
- …ensure optimal quality, cost, and service/outcomes. Supports and actualizes the UTMB Utilization Review/ Case Management program by utilizing clinical ... + Supervises the operational management of the Utilization Review/ Case Management program to...Standard office equipment. **_WORK ENVIRONMENT_** **:** + May involve travel . + May involve occasional shift work and weekends… more
- Houston Methodist (Houston, TX)
- …(MSW) + Master's in nursing preferred **WORK EXPERIENCE** + Five years experience in inpatient case management , social work or utilization management or ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
- Houston Methodist (Houston, TX)
- …Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work department. This position is an integrated, ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
- HCA Healthcare (Dallas, TX)
- …+ Lead centralized case management function, including Clinical Case Management , Utilization Review Services, and Clinical Documentation Improvement. ... HCA established policies, practices, efficiencies; and effectiveness of clinical Case Management , Utilization Management...preferred + The job may require up to 50% travel Knowledge, Skills Abilities & Behaviors: + Lead centralized… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Management (CM) Coordinator position is a proficient CM representative that provides technical, clerical and data management ... and social work department staff to facilitate efficient utilization of resources and discharge planning. This position performs...of duties of a higher complexity in support of Case Management operations including referrals management… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case ... management and social work department to facilitate efficient utilization of resources and discharge planning including referrals ...administrative duties of a higher complexity in support of Case Management operations. In addition, the CM… more
- CVS Health (Austin, TX)
- …to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management , ... healthcare decision-making. Monitoring, Evaluation, and Documentation of Care; - Utilizes case management processes in compliance with regulatory and… more
- HCA Healthcare (Anchorage, AK)
- …You will integrate and coordinate care facilitation, discharge planning functions and utilization management . + You will lead the Case Management team in ... 2+ years of supervisory experience preferred. + Certification in Case Management or Utilization Review...across the country offering our colleagues the opportunity for travel and relocation. HCA Healthcare and Alaska Regional are… more
- Immigration and Customs Enforcement (Washington, DC)
- …Health Service Corps (IHSC). The incumbent will report directly to the Medical Case Management Program Manager (MCMPM). This is a non-supervisory position. This ... Advanced Practice Registered Nurse or Physician Assistant/Associate with clinical and case management experience. Minimum four years of clinical experience… more
- ChenMed (St. Louis, MO)
- …of 2 years' clinical work experience required + A minimum of 1 year of utilization review and/or case management , home health, discharge planning experience ... by either the RN or LPN include: + Conducts utilization view for appropriate utilization of services...required + A minimum of 1 year of case management experience in acute case… more
- HCA Healthcare (Dallas, TX)
- …in 21 states and the United Kingdom. We are looking for a Manager of Case Management for our Medical City Dallas team where excellence creates excellence. ... Do you want to be an influencer in healthcare? **Apply for our Manager of Case Management role today!** **Job Summary and Qualifications** + The Manager for … more
- CVS Health (Charleston, WV)
- …* Foster care experience * DoHS Experience * Crisis intervention skills * Managed care/ utilization review experience * Case management and discharge planning ... full-time field teleworker position that requires West Virginia residency. Travel is required 50% of the time or more,...critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare… more
- LifePoint Health (Rutherfordton, NC)
- …knowledge and experience operating community hospitals and healthcare organizations. The Director of Case Management is responsible for the oversight of Case ... Accountable for the execution, adaptation and outcome of care management as prescribed in the initial Utilization ...from admission through discharge. Educates Physicians and staff in Case Management standards and assists them in… more
- ChenMed (Philadelphia, PA)
- …+ Directs referrals to preferred providers. + Coordinates the integration of social services/ case management functions in the pre-acute, ER, acute and post-acute ... Coordinates the patient care, discharge and home planning processes with hospital case management departments, and other healthcare facilities. + In conjunction… more
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