- Appcast (Randallstown, MD)
- Utilization Review Nurse RN Randallstown, MD NORTHWEST HOSPITAL NW CARE MANAGEMENT Full-time - Day shift - 8:00am-4:30pm RN Other 92327 $38.20-$59.21 Experience ... contribute to a system that values bold ideas and community-centered care. The Utilization Review Nurse RN conducts initial, concurrent and retrospective chart … more
- Virtua Health (Pennsauken, NJ)
- …necessity tools to maintain compliance and achieve cost effective and positive patient outcomes .Acts as a resource to other team members including UR Tech and AA ... to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to assist in the… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Utilization Review Manager * **Location:** *MN-Minneapolis-Downtown Campus* **Requisition… 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 ... who provide expert nutritional interventions to improve patient health outcomes . **Join Our Team of Experts and Serve Your...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** + ... of InterQual Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of CMS Regulations. **Working… more
- State of Indiana (Indianapolis, IN)
- …role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose of ... Utilization Management Manager Date Posted: Sep...you will ensure Indiana Medicaid members achieve positive health outcomes through access to high quality care and services.… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management-Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... leader for system services for wholly owned and Partner hospitals for utilization management. Job Duties OPERATIONS: Plans, organizes and delegates activities as… more
- Humana (Augusta, ME)
- …Registered Nurse (RN) license in the state of Michigan. + Previous experience in utilization management and/or utilization review . + Minimum of two (2) ... caring community and help us put health first** The Manager , Utilization Management Nursing (LTSS Utilization...and mitigate inefficiencies and provide solutions to improve clinical outcomes . + Collect and analyze data as necessary to… more
- Molina Healthcare (GA)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- Catholic Health Services (Melville, NY)
- …why Catholic Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and ... compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time. We are...additional clinical documentation. + Acts as liaison between the Utilization and Appeals Management Department and the physician of… more
- Northeast Alabama Regional Medical Center (Anniston, AL)
- …years of clinical experience required. Leadership experience preferred. CM or Utilization Review experience preferred. Extensive knowledge and understanding of ... stay reviews to assure hospitalizations meet payor requirements. Maintains records of review information and outcomes for billing purposes and for compliance… more
- Prime Healthcare (Chino, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226811/case- manager -%28rn%29 utilization ... among the 100 Great Community Hospitals by Becker's Hospital Review in 2018 and as among the 100 Top...insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization ... to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent … more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/226814/case- manager utilization ... to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a holistic and comprehensive admission and concurrent … more
- Catholic Health Services (Melville, NY)
- …services and coordinates utilization /appeals management review . + Assist Utilization and Appeals Manager in setting up communications with payors and/ ... compassionate care and utilize evidence based practice to improve outcomes - to every patient, every time. We are...and facility departments. + Develops/validates daily work lists for Utilization and Appeals Manager . + Assist with… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... the safety net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for… more
- Elevance Health (Wallingford, CT)
- …Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be ... must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US… more
- AmeriHealth Caritas (Philadelphia, PA)
- … Management, provides organizational leadership in the operational areas of appeals, utilization review , quality improvement, and related policy and practice ... initiatives in collaboration with the Corporate Medical Directors, Utilization Management and the Vice President, Medical Affairs. ; **Work Arrangement:** + Remote… more
- Molina Healthcare (Orlando, FL)
- … Manager . + Identifies and implements programs to improve clinical outcomes stemming from medication selection, utilization , and adherence. **JOB ... management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services… more
