- Sharp HealthCare (San Diego, CA)
- …You Will Do** As a member of the System Integrated Care Management (ICM) team the Utilization Manager ( UM ) II position supports utilization review ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- Sharp HealthCare (San Diego, CA)
- …of the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- LA Care Health Plan (Los Angeles, CA)
- …required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible for receiving/reviewing ... Utilization Management Admissions Liaison RN II ...vs. observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II ...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals and clinical improvement ... **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare...formal educational lectures and engage in frequent informal meetings ii . Retrospective Medical Record Documentation Review iii. Clarifying ambiguous… more
- Elevance Health (Seven Fields, PA)
- …Monday-Friday 8:00 am -5:00 pm Eastern Standard Time The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse or ... necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more
- Elevance Health (Las Vegas, NV)
- …and insightful analytics to improve the delivery of care. **Behavioral Health Care Manager II ** Location: This position is primarily a virtual/remote role. ... pm, Pacific Standard Time Zone.** The **Behavioral Health Care Manager II ** is responsible for managing psychiatric...healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to… more
- Elevance Health (Costa Mesa, CA)
- **Sign-on Bonus:** $3,000 The **Behavioral Care Manager ** ** II ** is responsible for completing clinical assessments, screenings, and managing crisis calls in a ... quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Outreaches to providers as necessary for… more
- Elevance Health (Rocky Hill, CT)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and… more
- Elevance Health (Latham, NY)
- …Monday-Friday 8:00 am -5:30 pm Eastern Standard Time The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse or ... necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... Equipment (DME) forms and patient status reports.Anticipates and completes documentation needs (ie UM , Plan of Care (POC), patient status reports) prior to their due… more
- Centene Corporation (Mcallen, TX)
- …cost effective care. + Assess the member's current health status, resource utilization , past and present treatment plan and services, prognosis, short and long ... + Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience + Enter and maintain assessments, authorizations, and… more
- LA Care Health Plan (Los Angeles, CA)
- …member care with internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social ... and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required… more
- Houston Methodist (Nassau Bay, TX)
- …percentage, and other areas according to department specifications. + Manages utilization management ( UM ) programs including Medical Claims Review, ... At Houston Methodist, the Manager Case Mgmt Social Svcs position is responsible...care to patients and while promoting the most cost-effective utilization of the hospital's resources. This position maintains accountability… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- Summary The Assistant Nurse Manager (ANM) of Centralized Nurse Staffing Office & Utilization Management (CNSO & UM ) reports to the Nurse Manager of the ... management of the assigned areas of responsibility. The ANM of CNSO & UM demonstrates performance and leadership that improves safe, cost effective and medically… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... to the PT Supervisor or supporting clinical specialist (PT II or PT III) for resolution in a timely...and patient status reports.Anticipates and completes documentation needs (ie UM , POCs, patient status reports) prior to their due… more
- ChenMed (Louisville, KY)
- …performance of the center, as the true dyad partner to the Center Manager /Center General Manager . Directly supervise, performance manage and train PCPs in ... Leads SH and Transforming Care Meeting (TCM) weekly, as well as supports Center Manager /Center General Manager in other center meetings. SMD partners with Center… more
- Queen's Health System (Kaunakakai, HI)
- …hospital-wide and Medical Staff Performance Improvement (PI), Utilization Management ( UM ), Infection Control (IC) and Employee Health. II . TYPICAL PHYSICAL ... setting. I. JOB SUMMARY/RESPONSIBILITIES Responsible to the Physical Therapy Manager . Provides inpatient and outpatient Physical Therapy services. Prepares all… more