- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... Utilization Management and Review for...Utilization Management and Review for the Enterprise. The...team in delivering and collaborating on all aspects of utilization management and care coordination… more
- Guthrie (Binghamton, NY)
- Provides health care services regarding admissions, case management , discharge planning and utilization review . Responsibilites: Reviews admissions and ... planning needs with healthcare team members. May prepare statistical analysis and utilization review reports as necessary. Oversees and coordinates compliance to… more
- AmeriHealth Caritas (Philadelphia, PA)
- …in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience utilizing ... care to those who need it most. We offer integrated managed care products, pharmaceutical benefit management and specialty pharmacy services, behavioral… more
- BayCare Health System (Tampa, FL)
- …system level with clinical reviews and data analysis in collaboration with the Care Management , Utilization Review /Denials, Clinical Documentation ... remotely?** Always **Equal Opportunity Employer Veterans/Disabled** **Position** APRN - Utilization Management /Physician Advisor Services **Location** Tampa:St Josephs… more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote...with hospital administration and clinical teams. + Experience in utilization management and care coordination.… more
- Cleveland Clinic (Stuart, FL)
- …of eligibility (CTM, ACM, CCM or AHA) + 2 years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... Hospital where research and surgery are advanced, technology is leading-edge, patient care is world-class, and caregivers are family. This downtown Stuart hospital… more
- Cleveland Clinic (Garfield Heights, OH)
- …eligibility (CTM, ACM, CCM or AHA) + Two years of recent experience in utilization review , quality or care management + Knowledge of acute care and ... and the Southeast communities of Cuyahoga County, Marymount Hospital is an acute care , faith-based hospital. Here, caregivers are guided by the Christian values of… more
- Cleveland Clinic (Beachwood, OH)
- This position requires 2 years of experience in Utilization Review , Quality or Care Management , Disability Plans, FMLA and ADAA** Join the Cleveland ... nursing experience + Two years of experience in Utilization Review , Quality or Care Management , Disability Plans, FMLA and ADAA Preferred qualifications… more
- Providence (Hood River, OR)
- …year of Home health, mental health, substance use, hospice, utilization review , discharge planning or care management experience **Preferred ... ongoing monitoring of plan effectiveness and reassessment of the need for Care Management (CM) services. Providence caregivers are not simply valued - they're… more
- Ellis Medicine (Schenectady, NY)
- …by the Case Manager include, but are not limited to, utilization review , case management , care transition, collaboration with physicians and social ... years of inpatient experience in a hospital environment preferred. + Previous case management , utilization review , and discharge planning experience highly… more
- Community Health Systems (Franklin, TN)
- …Degree in Nursing preferred + 2-4 years of clinical experience in utilization review , case management , or acute care nursing required + 1-3 years ... and collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review ...and payer requirements. + Documents all utilization review activities in the hospital's case management … more
- Martin's Point Health Care (Portland, ME)
- …nursing or care management desired (CMCN or CCM) Utilization Review Nurse Skills/Knowledge/Competencies (Behaviors): + Demonstrates an understanding of ... care , prevent or reduce hospital admissions where appropriate. Utilization Review Nurse Key Outcomes: + ...management experience in a health plan UM department Utilization Review Nurse Required License(s) and/or Certification(s):… more
- UNC Health Care (Hendersonville, NC)
- …continuity of care and cost effectiveness through the integrating and functions of care management , utilization review and discharge planning. The ... based on approved criteria and standards per the Hospital Utilization Review Plan. Directs delivery of notifications...Pardee UNC Health Care Organization Unit: Acute Care Case Management Work Type: Full Time… more
- Alameda Health System (Oakland, CA)
- System Utilization Management SUM Utilization Review RN + Oakland, CA + Highland General Hospital + SYS Utilization Management + Full Time - ... + Posted:Today **Summary** **SUMMARY:** The System Utilization Management [SUM] Utilization Review RN...healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care )… more
- Corewell Health (Farmington Hills, MI)
- …planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... Required + 3 years of relevant experience Three to five years' experience in care management , utilization review , home care and/or discharge… 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 ...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Tenet Healthcare (Detroit, MI)
- …and advance Tenet’s Case Management strategy with the specific focus on Utilization Review for the designated Market. Will support the advancement of ... initiatives and will provide subject matter expertise for Case Management – Utilization Review regulations...Coordinates clinical care (medical necessity, appropriateness of care and resource utilization for admission, continued… more
- Stanford Health Care (Palo Alto, CA)
- …Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge planning. + ... management - 3+ years of experience in utilization review Why work at Stanford Medicine...mentoring would further develop our robust, Utilization Management team. Are you driven by health care… more
- Intermountain Health (Murray, UT)
- …in clinical nursing. + Minimum 1 year experience in care management /navigation or closely related field including: Utilization Management , discharge ... Qualified Health Plans, fully funded and self-funded Commercial plans. Utilization Review nurses at Select Health proactively...member. + Recognizes members unique needs and refers to Care Management , Pharmacy, Appeals, or other products,… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... UTILIZATION REVIEW NURSE SUPERVISOR I Print...Review Nurse is an RN that has Case Management experience whose primary charge is to ensure that… more