- 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,...PPD vendors: medical supplies, durable medical equipment, and pharmacy utilization . + Works closely with branch leadership to identify… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …and goal of sustaining high quality care/service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review/quality and appropriateness requirements. What qualifications do you need: + Bachelor… 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 ... appropriate. + Assist in developing and administering policies and procedures for utilization . + Negotiating access to care for individuals seeking services at Helio… more
- Tufts Medicine (Burlington, MA)
- …assisting with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization ... payment processing. In addition, this role focuses on performing the following Utilization duties: Ensures the delivery of clinical services is appropriate and… more
- CoreCivic (Brentwood, TN)
- …will pay $82,000 - $97,400 with a 10% bonus eligible._ **SUMMARY:** The Manager , Utilization Management/Case Management provides Utilization Review and Case ... a responsibility to better the public good. CoreCivic is currently seeking a ** Manager , Health Services Audits** located at our corporate office in Brentwood, TN.… 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 ... from payors for additional clinical documentation. Acts as liaison between the Utilization and Appeals Management Department and the physician of record, as… more
- Trinity Health (Mason City, IA)
- …Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case screening, insurance ... Works directly with members of care team to effectively ensure appropriate acute utilization management + Interacts with outside review agencies and payors to inform… 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 ... to help patients access the full range of their benefits through the utilization review process. + Conducts admission reviews. + Conducts concurrent and extended… more
- LifePoint Health (Gallatin, TN)
- …or related healthcare field. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Mgmt Case Manager FT* **Location:** *Tennessee-Gallatin* ... Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays.… 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 Center ... Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and monitors quality assurance for Lahey Clinic inpatient… 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 ... Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding UR and… more
- Humana (Frankfort, KY)
- …part of our caring community and help us put health first** The Manager , Behavioral Health Utilization Management uses clinical knowledge, communication skills, ... department. **_Detailed Responsibilities include:_** Leads Kentucky Medicaid Behavioral Health Utilization Management process and teams responsible for supporting **_Behavioral… 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
- UCLA Health (Los Angeles, CA)
- …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 to a team ... (BSN) degree required + Five or more years of utilization management required + Four or more years of...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- Ochsner Health (New Orleans, LA)
- …efficiently in high pressure situations. Preferred- Experience in Case Management or Utilization Review Business and Financial Knowledge as well as understanding of ... Health Care Delivery Systems **Certifications** Required - Current RN License in the state of practice. **Knowledge Skills and Abilities (KSAs)** + Must have computer skills and dexterity required for data entry and retrieval of patient information. + Must be… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... based on medical necessity. 2. Performs concurrent and retrospective utilization management-related activities and functions to ensure that appropriate data… more
- Ascension Health (Baltimore, MD)
- …Manage activities, workflow and resources of assigned nursing travelers. + Ensure compliance with regulatory and accreditation requirements for their assigned team. + ... **Details** + **Department:** Ascension Travel Program & Interim Leadership + **Schedule:** Full-time + **Hospital:** St. Agnes + **Location:** Baltimore, MD * Rates may vary by location and specialty. Stipends follow GSA guidelines based on the zip code of… more
- Centene Corporation (Olympia, WA)
- …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...applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- Providence (Anaheim, CA)
- **Description** Under the direction of the Utilization Supervisor/ Manager , this position is responsible for the distribution, review, accurate and timely ... Assistant Certification (CMA) upon hire. + 1 year of experience in utilization management or case management with experience in medical terminology and coding.… more
- Trinity Health (Lavonia, GA)
- **Employment Type:** Full time **Shift:** **Description:** The RN Case Manager (RN CM), works in collaboration with a multidisciplinary team by identifying and ... level of care throughout hospitalization in compliance with CMS and organizational utilization management requirements. RN CM helps to ensure medical necessity is… more
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