- Healthfirst (NY)
- …case management, identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... This position is 100% Remote** **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes: + Pre-certification… more
- Queen's Health System (Honolulu, HI)
- …manages administrative and clinical operations of Emergency Department and Inpatient Case Management services. * Develops, implements, monitors and evaluates for ... (5) years nursing experience with at least three (3) years experience in Case Management. * Two (2) years supervisory/leadership experience. * Prior experience in a… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of service authorization data validation, reporting and trend ... provider invoices, reviews line-by-line entries, and submits to finance for payment. The UM Program Manager reconciles ARGOS Dependency Cases to FSFN for… more
- Fallon Health (Worcester, MA)
- …and/or G drive. + Manage applicable queues in both the core system (QNXT UM and Call Tracking) and the case management application (TruCare). + ... **Brief Summary of Purpose:** Under the direction of the Manager of Prior Authorization, communicates with contracted and non-contracted… more
- Molina Healthcare (GA)
- …The license must be active and unrestricted in state of practice. Certified Case Manager (CCM), Certified Professional in Health Care Management certification ... JOB DESCRIPTION **Job Summary** The Supervisor, Healthcare Services UM leads and supervises a multidisciplinary team of...Georgia RN licensure and at least 3 years of UM experience. The candidate must have strong organization, communication,… more
- Molina Healthcare (Orlando, FL)
- …medications safety and medication use policies). **KNOWLEDGE/SKILLS/ABILITIES** The Pharmacist, UM will be responsible for reviewing coverage determinations and ... in a timely, compliant, and accurate manner. The Pharmacist, UM will also be responsible for serving as a...changes for the upcoming year. + Works with the Case Management department as part of a member-centered interdisciplinary… more
- Elevance Health (Chicago, IL)
- …**How you will make an impact:** + Ensures timely completion of clinical case reviews for their board certified specialty. + Makes physician to physician calls ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director review or...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Sharp HealthCare (San Diego, CA)
- …Professional in Healthcare Quality (CPHQ) - National Association for Healthcare Quality; Certified Case Manager (CCM) - Commission for Case Manager ... - National Association for Healthcare Quality -PREFERRED + Certified Case Manager (CCM) - Commission for ...and enforce policies and procedures for HSM that involve Case Management and UM . Serves as the… more
- ERP International (Yuma, AZ)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager ** for a full-time position at the Camp Pendleton **Branch Health Clinic** in ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...for professional growth and development as related to the case manager position and maintenance of CM… more
- OhioHealth (Columbus, OH)
- …- in our careers and in our communities. **Job Description Summary:** The Case Manager extender works collaboratively with all interdisciplinary staff internal ... room and bed charges and performing charge reconciliation. The case manager extender is well organized, highly...utilization management/clinical decisions beyond level of authority to care coordination/ UM team and Manager /Director of UM… more
- HCA Healthcare (Lake City, FL)
- …Healthcare colleagues invested over 156,000 hours volunteering in our communities. As a(an) RN Case Manager Part Time with HCA Florida Lake City Hospital you can ... our organization. We are looking for an enthusiastic RN Case Manager Part Time to help us...condition and insurance company request and documents in the UM module. + Performs initial screening of identified patients… more
- HCA Healthcare (Lake City, FL)
- …**Introduction** Do you want to join an organization that invests in you as an RN Case Manager PRN? At HCA Florida Lake City Hospital, you come first. HCA ... a difference. We are looking for a dedicated RN Case Manager PRN like you to be...condition and insurance company request and documents in the UM module. + Performs initial screening of identified patients… more
- ERP International (Cherry Point, NC)
- **Overview** ERP International is seeking full-time **Registered Nurse (RN) Case Manager ** in support of theNaval Health Clinic Cherry Point, NC. Apply online ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...Possess one of the following certifications:** **o** Commission for Case Manager Certification Certified Case … more
- UNC Health Care (Raleigh, NC)
- **Description** **Our Case Management team is seeking a System-wide Complex Case Manager to provide support to a network of 6 owned and 10 managed ... teams, and will report to the Regional Director of Case Management.** Become part of an inclusive organization with...CAPP as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting… more
- ERP International (Macdill AFB, FL)
- …Collegiate Nursing Education (CCNE). **Experience:** Minimum 1 years experience as a RN Case Manager within the past 24 months. Certification:** Possess one of ... for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with...the following certifications: o Commission for Case Manager Certification Certified … more
- ERP International (Tinker AFB, OK)
- **Overview** ERP International, LLC is seeking a **Registered Nurse - Case Manager ** for a full-time position supporting **SHG Clinic** in support of **Tinker ... Medical Evaluation Unit (THMEU) in San Antonio, Tx. The Case Manager will be required to attend...for community resources. * Integrate CM and utilization management ( UM ) and integrating nursing case management with… more
- Meriter-UnityPoint Health (Madison, WI)
- …Description: Shift: 0.0FTE, Per Diem, 0-40 hours per week, Day Shift. The RN Case Manager (CM) collaborates with the interdisciplinary care team in the ... approach to patient care and discharge planning. The RN Case Manager collaborates and maintains close partnership...The RN CM collaborates with the Enterprise Utilization Management ( UM ) RNs and Coordinators to communicate the plan for… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for you, we encourage you to apply! Job Description: Summary: Conducts case management program activities in accordance with departmental, corporate, NYS Department ... for Quality Assurance (NCQA) accreditation standards, as appropriate to the member's case assignment. Uses a systematic approach to identify members meeting program… more
- Stony Brook University (Stony Brook, NY)
- Case Manager - Part Time Temporary **Position Summary** At Stony Brook Medicine, a **TH Staff Associate/ Case Manager ** is a valuable member of our team, ... high standard of excellence. **Duties of a TH Staff Associate/ Case Manager in the Care Management Department...their work and follow up with cases. **Preferred:** CM, UM , Quality, Coding, Risk or MCG Certification Working knowledge… more
- Dartmouth Health (New London, NH)
- …care and resulting outcomes. * FUNCTIONAL DUTIES AND RESPONSIBILITIES * Clinical Case Management * Determines patient needs and resources within 1-2 business days ... of admission. Initiates discharge planning process. Maintains communication with UM coordinator regarding assessments, outcomes, and projected lengths of stay.… more