- BroadPath Healthcare Solutions (Tucson, AZ)
- **Overview** BroadPath is seeking a highly motivated and results-driven ** UM RN Appeals Coordinator .** This role collaborates with clinical review staff, medical ... directors/physician reviewers, network physicians, and network facilities to ensure consistent clinical evaluation and processing of medical necessity appeals. Accurate documentation and detailed recordkeeping of notifications to members and network providers… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management ( UM ) program for all TRICARE eligible beneficiaries within the CMHS. ... **ESSENTIAL DUTIES & RESPONSIBILITIES** + Act as coordinator /liaison with providers, staff and Managed Care Support Contractor...utilization management. + One (1) year of experience in UR/ UM and three (3) years of clinical nursing experience.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The UM Coordinator is responsible for coordinating all aspects of the prior authorization process, including member eligibility and benefit ... verification, gathering necessary clinical information from electronic medical record, and timely communication with members, providers and facility staff. Candidates should possess knowledge of third-party reimbursement regulations and medical terminology.… more
- Centers Plan for Healthy Living (Margate, FL)
- …plans they need for healthy living. JOB SUMMARY: The Utilization Management Care Coordinator works within a multidisciplinary care team to assist with the care of ... members enrolled in our Managed Long Term Care program and facilitate authorization requests for eligible members. PRIMARY RESPONSIBILITIES: + Assists in the prior authorization of services and ongoing authorization requests + Assists in completing… more
- Health Care Service Corporation (Helena, MT)
- …to obtain multi-state licenses. **Preferred Job Qualifications:** + Familiarity with UM /CM activities and standardized criteria set. + Knowledge of ancillary ... services including HHC, SNF, Hospice, etc. **Telecommute:** This is a Telecommute (Remote) role: Must reside within 250 miles of the office or anywhere within the posted state. \#LI-TELECOMMUTE \#LI-SG1 **Are you being referred to one of our roles? If so, ask… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …The Licensed Vocational Nurse plays a vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case ... Managers, support staff, insurance payers, and post-discharge vendors to ensure safe, timely, and efficient transitions of care. This coordination not only supports optimal patient outcomes but also helps ensure appropriate hospital reimbursement for services… more
- Integra Partners (Troy, MI)
- The UM Coordinator assists and supports the clinical team ( UM Nurses/Medical Director) with administrative and non-clinical tasks related to processing ... HCPC codes + Maintaining expected timelines EXPERIENCE: + 1 year as a UM Coordinator in a managed care payer environment preferred + Knowledge of ICD-10, HCPCS… more
- Humana (Frankfort, KY)
- …our caring community and help us put health first** The Referrals Coordinator 2 process referrals from Military Treatment Facilities (MTFs) and civilian providers. ... The Referrals Coordinator 2 performs varied activities and moderately complex administrative/operational/customer...Military referral processes, MOUs with MTFs, and referral and UM policies. + Answers questions or contacts MTFs and/or… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross and Blue Shield of Minnesota Position Title: Health Support Coordinator Location: Remote Career Area: Customer Service/Operations About Blue Cross and ... to make a difference, join us. The Impact You Will Have The Health Support Coordinator (HSC) is a member of the Blue Cross Blue Shield of Minnesota (BCBSMN) Care… more
- Fallon Health (Worcester, MA)
- …for incoming calls from the multiple ACD lines for the UM department addressing and/or referring customer (provider/member) calls/inquiries, provide direction ... Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application...focus toward excellent customer service. In addition, the Service Coordinator will attain the targets for a customer service… more
- Dignity Health (Los Angeles, CA)
- …bonus not to exceed 10% of salary for this position. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for ... identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost… more
- University of Michigan (Ann Arbor, MI)
- Community Outreach Coordinator (TERM-LIMITED) Apply Now **How to Apply** A cover letter is required for consideration for this position and should be attached as the ... and Rehabilitation (PM&R) seeks a qualified candidate for the position of Community Outreach Coordinator to join our team. This role will support the work of the… more
- CommonSpirit Health (West Jordan, UT)
- …help you flourish and leaders who care about your success. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for ... identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost… more
- Dignity Health (Phoenix, AZ)
- …the mission of the Hospital. **Job Summary / Purpose** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for ... identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost… more
- University of Michigan (Ann Arbor, MI)
- Activity Coordinator Apply Now **Mission Statement** Michigan Medicine improves the health of patients, populations and communities through excellence in education, ... as a member of the Child & Family Life team, the Activity Coordinator is responsible for the daily operation and supervision of hospital activity centers.… more
- Dignity Health (Merced, CA)
- **Job Summary and Responsibilities** **Position Summary** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for ... identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost… more
- Dignity Health (Long Beach, CA)
- **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients ... requiring these services. The RN Care Coordinator performs this role to meet the individual's health...Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed care and… more
- Catholic Health Initiatives (Chattanooga, TN)
- **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients ... requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost effective outcomes… more
- CommonSpirit Health (Lakewood, CO)
- …help you flourish and leaders who care about your success. The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for ... identified patients requiring these services. The RN Care Coordinator performs this role to meet the individual's health needs while promoting quality of care, cost… more
- Dignity Health (Bakersfield, CA)
- **Job Summary and Responsibilities** The RN Care Coordinator is responsible for overseeing the progression of care and discharge planning for identified patients ... requiring these services. The RN Care Coordinator performs this role to meet the individual's health...Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Knowledge of managed care and… more
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