- 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 … more
- UNC Health Care (Smithfield, NC)
- …of case management, utilization review and discharge planning. The Care Manager must be highly organized professional with great attention to detail, ... processing) to Care Management Assistant. Consult Social Worker and/or Utilization Manager per established departmental protocol. Maintain knowledge of… more
- Beth Israel Lahey Health (Burlington, MA)
- …The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors ... a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse...care experience. -Two years of Case Management or Utilization Management experience desirable. - Demonstrated ability to communicate… 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 ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Stanford Health Care (Palo Alto, CA)
- …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. ... an RN - 3+ years of experience in case management/ utilization review Why work at Stanford Medicine...while honoring its commitment to delivering evidence-based and patient-centered care . We are seeking a results-driven manager … more
- Houston Methodist (The Woodlands, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and… more
- Ascension Health (Baltimore, MD)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... implement quality review programs and key performance indicators for all utilization review activities. + Interact with medical, nursing, and executive… 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 ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred. +… more
- Trinity Health (Mason City, IA)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **JOB SUMMARY:** The Utilization Review Case Manager responsibilities include case ... you will do:** + Works directly with members of care team to effectively ensure appropriate acute utilization... care team to effectively ensure appropriate acute utilization management + Interacts with outside review … more
- Whidbey General Hospital (Coupeville, WA)
- …and background to assure compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning. The RN - Care Manager will ... anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management/ Utilization Plan...Management/ Utilization Plan that integrates the functions of utilization review , discharge planning, and resource management… more
- Tenet Healthcare (Detroit, MI)
- Group Utilization Review Director - 2506000536 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... diverse employers in Southeast Michigan. Summary Description SUMMARY: The Group Director, Utilization Review will perform the functions necessary to support and… more
- Alameda Health System (Oakland, CA)
- …trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care ) by participating in appropriate ... System Utilization Management SUM Utilization Review...in orientation of fresh staff as requested by the Manager of Utilization Management. 17. Maintains knowledge… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/204105/case- manager %2c-rn utilization - review ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… 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 ... hospital setting and to ensure patients progress along the continuum of care . RN CM facilitates patient transitions efficiently and in a cost-effective manner… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual review of the Utilization … 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 ... appropriateness of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works...standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of care … more
- Dignity Health (Santa Cruz, CA)
- …Key Job Responsibilities** + _Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the ... for appropriate status determination._ + _Ensures compliance with principles of utilization review , hospital policies and external regulatory agencies, Peer… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective ... + Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines...five (5) years of nursing experience + Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or… more
- Centene Corporation (Olympia, WA)
- …, and/or Retrospective Review Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care ... operations within utilization management. + Manages prior authorization, concurrent review , and retrospective clinical review team and ensures compliance… 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 ... payer contract to obtain authorization for appropriate level of care and length of stay as needed. 4. Obtains...related field + Two years of case management or utilization review , billing, or coding experience +… more
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