- Elevance Health (Chicago, IL)
- …operations managers who will perform clinical reviews for a set of Post Acute Care Utilization Management solutions and complex cases such as home ... or a UM/benefits management firm - Utilization management or clinical experience with post - acute care, especially wound care -Certified Wound care… more
- Sutter Health (San Mateo, CA)
- …Overview:** This position coordinates the utilization management , resource management , discharge planning, post - acute care referrals and care ... interview patient/family and determine preferences for post - acute care services. Utilization Management . * Completes initial InterQual review screening… more
- ChenMed (Chicago, IL)
- …Coordinates as needed with the transitional care team, hospital, skilled nursing facility, post - acute , utilization management , and home-based services ... PCP requests for external cardiology referrals and participates in delegated utilization authorizations; determines level of urgency of follow-up, referral /… more
- ChenMed (Houston, TX)
- …Assists and coordinates, in conjunction with the transitional care team; hospital, SNF, post - acute , delegated utilization management and home-based ... Director/Manager, Center Managers, external sub-specialists and providers in hospitals and post - acute care facilities. **KNOWLEDGE, SKILLS AND ABILITIES:** +… more
- Sutter Health (Salt Lake City, UT)
- …**Organization:** SHSO-Population Health Services-Valley **Position Overview:** This position facilitates utilization management (UM) processes to support that ... knowledge of laws, regulations and professional standards affecting case management practice in an integrated delivery system: including but...CDPH and TJC. + A broad knowledge base of post - acute levels of care and associated regulatory… more
- Kaleida Health (Buffalo, NY)
- …equity, and any applicable collective bargaining agreement.* **Grade:** 600 **Position:** VP Care Management Post - Acute Care Transition **Union Code:** 00 - ... executive leadership and guidance for critical areas of Care Management (CM), Discharge Planning and Post - Acute...related or Business field preferred. 10 years of care management / utilization management experience required in… more
- Elevance Health (Columbus, OH)
- …with Managed Care, Utilization Management , Prior Auth, and Benefits Management decision support in the Post - Acute Domain, DME, Home Health, ... as part of consideration for employment. **National Medical Director, Post Acute Solutions** + Job Family: MED...enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease… more
- Elevance Health (Walnut Creek, CA)
- …CA, PALO ALTO **Description** **Clinical Operations Associate Medical Director** **Carelon Insights** ** Post Acute Care Utilization Review** Schedule: 11-8 ... you for payment as part of consideration for employment. **Associate Medical Director - Post Acute Care** + Job Family: MED > Licensed Physician/Doctor/Dentist +… more
- SSM Health (Jefferson City, MO)
- …currently seeking a Clinical Informatics System Support Manager to support our Care Continuum ( Post - Acute ) processes! This role would be perfect for a RN that ... standardization and innovative approaches, while driving performance improvement, increased utilization & engagement, and transformation & innovation of care… more
- Ventura County (Ventura, CA)
- …the interdisciplinary approach to providing continuity of care, including Utilization management , Transfer coordination, Discharge planning, and obtaining ... health care facilities; responsible for complying with AB 1203, Post Stabilization notification; and complies with other duties as...No 03 Please detail your nursing experience with Case Management , Utilization Management , and discharge… more
- Providence (Seattle, WA)
- …Medicare 5-Star, NCQU and/or URAC (preferred) + Knowledge of principles and practice of acute utilization management + Knowledge of evidence-based practice + ... **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus… more
- LA Care Health Plan (Los Angeles, CA)
- …in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests where determination requires extended ... Utilization Management Admissions Liaison RN II...Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care/ post -stabilization admission… more
- Sharp HealthCare (San Diego, CA)
- …the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. This position ensures ... ensure appropriate patient status and assists with repatriation and post -stabilization reviews for patients before the patient is bedded,...Degree in a health related field + 3 Years Utilization Management or case management … more
- UNC Health Care (Raleigh, NC)
- …stay, and discharge reviews in accordance with federal regulations & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is ... and payors), and assesses the patient care progression from acute care episode through post discharge for...management referrals. Initiates appropriate social work referrals. 3. Utilization Management Process - Performs utilization… more
- Actalent (San Bernardino, CA)
- …of patient care as it relates to acute inpatient stay and post - acute facility stay. The Utilization Review RN Coordinates continuing care/outside ... Description: As a part of the Utilization Management team the Utilization...RN License BLS AHA Must be experienced with Care Management Prior Authorizations Acute Outpatient experience -… more
- Beth Israel Lahey Health (Burlington, MA)
- …the healthcare team to coordinate and facilitate patient discharge. 14) Works with the Post Acute Care Coordinator to facilitate timely patient access to post ... . 7) Works with patients and families to facilitate post hospital care and develop plans to meet short...of medical/surgical nursing care experience. -Two years of Case Management or Utilization Management experience… more
- Munson Healthcare (Traverse City, MI)
- …of resources. + Assists in developing and revising policies to support utilization management activities, including criteria and guidelines for appropriate use ... colleagues and hospital associates at information meetings. + May represent Utilization Management on various committees, professional organizations, physician… more
- LA Care Health Plan (Los Angeles, CA)
- …varied clinical experience in an acute hospital setting. At least 2 years Utilization Management /Case Management experience in a hospital or HMO setting ... Utilization Management Nurse Specialist RN II...and Physician Advisor on case reviews for pre-service, concurrent, post -service and retrospective claims medical review. Monitors and oversees… more
- Universal Health Services (Dearborn, MI)
- Responsibilities Utilization Management Case Manager Beaumont Behavioral Health (a UHS Facility) A growing 144-bed behavioral health facility - Beaumont ... For more information, please visit our website: https://beaumontbh.com/ PositionSummary The Utilization Management Case Manager is primarily responsible for… more
- Prime Healthcare (Bloomington, IN)
- …the utilization review and appeals process as part of the denial management initiatives. Utilization review tech is responsible for coordinating phone calls, ... as assigned. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Minimum one year denials management experience in acute care setting highly preferred. 2. High… more