- 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 ... required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II is primarily responsible for receiving/reviewing… more
- University of Rochester (Rochester, NY)
- …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500016 Admissions Center-SMH Work Shift: UR - Rotating (United States of America) Range: ... **Responsibilities:** GENERAL SUMMARY Coordinates or manages inpatient and outpatient admissions , including bed assignments and the completion of preliminary… more
- Cedars-Sinai (Los Angeles, CA)
- …Assists with investigation and follow-up regarding customer complaints. + Serves as liaison with other units in the Admissions department. **Qualifications** ... of service cash collections and cash flow, and provide efficient and appropriate utilization of resources. Acts as a resource for team members by assisting with… more
- University of Rochester (Rochester, NY)
- …Subtype: Regular Time Type: Full time Scheduled Weekly Hours: 40 Department: 500016 Admissions Center-SMH Work Shift: UR - Rotating (United States of America) Range: ... financial eligibility, secures account for billing and coordinates account management through discharge Completes appropriate forms to complete Death Certificate… more
- Ventura County (Ventura, CA)
- Senior Registered Nurse - Hospital Management Utilization Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5061650) Apply Senior Registered ... Nurse - Hospital Management Utilization Salary $118,668.43 - $141,888.74 Annually...doctor to coordinate and screen for the appropriateness of admissions and continued stays. They make recommendations to the… more
- Community Health Systems (Franklin, TN)
- …preferred **Knowledge, Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and healthcare regulations. ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- CaroMont Health (Gastonia, NC)
- …to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments, ... to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management preferred.… more
- Martin's Point Health Care (Portland, ME)
- …of clinical nursing experience as an RN, preferably in a hospital setting + Utilization management experience in a health plan UM department Required License(s) ... been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high quality,… more
- Charter Care Health Partners (Providence, RI)
- …and Utilization Review Coordinator is responsible for bed management , reviewing intake assessments, verifying clinical appropriateness for services, coordinating ... admissions , and overseeing utilization review activities to...regulatory and payer requirements while serving as a key liaison between patients, providers, and insurance carriers. Education: Bachelor's… more
- Wellpath (Lemoyne, PA)
- … utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders, and ... **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization...to reduce length of inpatient stays and decrease ED admissions . + Evaluate and recommend policy improvement related to… more
- Sharp HealthCare (San Diego, CA)
- …with Rehab Medical Director and other Physicians regarding potential patient admissions . + Data Management Effectively monitors, collects, and reports ... management systems to monitor referral source patterns and utilization . Reports activity by referral source; and appropriately/strategically adjusts plans to… more
- Beth Israel Lahey Health (Plymouth, MA)
- …unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management ** Performs review of anticipated admissions utilizing InterQual ... This role is structured around four major functions + Utilization Management + Care Coordination + Discharge...satisfaction with the discharge from the ED Prevents unnecessary admissions for social reasons Functions as a liaison… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …management committee, in defining operational strategic objectives for the Utilization Management Program and serves as the liaison to other medical staff ... * Act as physician liaison between case management / utilization management and providers to...* Review and report on PEPPER metrics; (LOS, CMI, Re- admissions , OBS rates, and governmental audit measures) to Hospital… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Bassett Healthcare (Cooperstown, NY)
- …do The Logistics C3 RN is responsible for appropriate placement for patient admissions , coordinating and expediting admissions and transfers as well as ... Bassett Medical Center and throughout the network. Acts as a primary liaison between all service locations, support departments, other healthcare facilities, and in… more
- Mount Sinai Health System (New York, NY)
- …limited to: a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using ... **Job Description** **RN/Case Manager MSH Case Management FT Days** The Case Manager (CM) will...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Logan Health (Kalispell, MT)
- Logan Health Wellness & Pain Management is proud to offer some of the most comprehensive pain and wellness care in the United States. Job Description Summary Logan ... Health Wellness and Pain Management is looking for an LCSW, LCPC or LMFT...Duties: + Triages referrals from providers and ensures on-going liaison occurs with stakeholders as applicable to assigned area(s).… more
- Houston Methodist (Sugar Land, TX)
- …with clinical team partners. This position uses sound clinical judgement in the Utilization Management process and knowledge of regulatory requirements to make ... Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management and… more
- Community Health Systems (Carlsbad, NM)
- …+ Refers cases not meeting criteria to the Physician Advisor or Utilization Management Committee and ensures appropriate follow-up. + Identifies avoidable ... laws and Joint Commission standards. + Acts as a liaison to community agencies, providing resources and services for...experience required + 3-5 years of experience in care management or utilization review required + 1-3… more
- HCA Healthcare (Gainesville, FL)
- …to decisions regarding ER and interfacility transfer patients. + Serves as first line liaison for problem solving for Bed Management . + Actively functions as ... an on-going focus on quality and efficiency. + Screens admissions for appropriateness of level of care and bed...the patient flow program effectiveness as it relates to utilization review, resource management , and discharge planning… more