- Cambia Health Solutions, Inc (Vancouver, WA)
- …or Bachelor's Degree in Nursing or related field and 3 years of case management , utilization management , disease management , or behavioral health ... member's needs as identified in the assessment.Implementation: execution of the specific case management activities that will lead to accomplishing the goals set… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …other technological systems and is required to frequently apply a set of management principles to ensure smooth operations of the department. The Nurse Manager must ... and decision making in the areas of budget, personnel, patient services, physician relations and administrative or professional programs. He/she must be able to… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …and present periodic reports on the departments including quality, costs, profitability, physician utilization , market share, as well as potential opportunities ... and visibility across all campuses. Responsibility includes the vision, direction, management and coordination of clinical invasive cardiac services, and vascular… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …and present periodic reports on the Department including quality, costs, profitability, physician utilization , market share, as well as potential opportunities ... Minimum Job QualificationsLicensure or other certifications: Registered Nurse, Nurse Practitioner, Physician Assistant licensed in the state of Georgia in good… more
- Intrepid USA (Avon, IN)
- …with program/payer rules and physician ordersResponsible for efficient and effective utilization management in accordance with client needs, physician ... and training to caregiver staff and assures compliance with documentation and physician order requirements. The DOPS must be accountable for adherence to company… more
- Chase Brexton Health Care (Baltimore, MD)
- …quality, smooth patient flow, optimized patient access and cost effective utilization as well as financial sustainabilityPERFORMANCE MANAGEMENT * Provides medical ... including Microsoft office suite, electronic medical records and practice management systemEDUCATION AND/OR EXPERIENCE:* Experienced primary care physician … more
- Intrepid USA (Elizabethtown, KY)
- …with program/payer rules and physician orders.Responsible for efficient and effective utilization management in accordance with client needs, physician ... training to caregiver staff and assure compliance with documentation and physician order requirements.Additional duties for this Branch Director role include, but… more
- Trinity Health (Maywood, IL)
- …our small but mighty team to guide and manage Utilization Review and Management for the Loyola Physician Partners LPP) Health Plan, a delegated entity for ... preauthorization requests utilizing defined criteria. Collects, analyzes and communicates relevant utilization management information to insurers and third party… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote. The role requires a broad knowledge and focus ... on Utilization Management and Denials principles such as...necessity criteria. The role requires the ability to consistently lead , support, and coach UM/UR staff and leaders. The… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... the Saint Alphonsus Chief Clinical Officer. The Medical Director of Documentation and Utilization Excellence (MDDUE) is the lead provider for coordination and… more
- Dignity Health (Rancho Cordova, CA)
- …**Preferred Qualifications:** - 7 years UM experience with Charge/ Lead /Supervisory/ Management experience in Utilization Management department preferred. ... the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable for coordination of… more
- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... innovate health solutions that deliver maximum value and impact. Lead the Way is our rallying cry at Acentra...Summary: Our Utilization Management Appeals Nurse - LPN/RN will… more
- Houston Methodist (Houston, TX)
- JOB SUMMARY At Houston Methodist, the Lead Nurse Practitioner/ Physician Assistant (NP/PA) position is responsible for functioning as a clinical leader and ... as a preceptor by mentoring others regarding care of defined populations in resource utilization and time management . (EF) 3. Provides clinical guidance as a… more
- Trinity Health (Maywood, IL)
- …setting in collaboration with attending physicians. + Actively participates in the Utilization Management committee. **We offer our employees:** + Benefits from ... **Employment Type:** Full time **Shift:** Day Shift **Description:** Utilization Review- RN Reviewer- Regional Coverage for Loyola, Gottlieb and MacNeal Hospitals.… more
- CenterWell (Atlanta, GA)
- **Become a part of our caring community and help us put health first** The Physician Lead serves as a health-care professional and capable of handling a variety ... of health-related problems. The Physician Lead works on problems of diverse...of GA. + Consults with advance practice providers on management of complex patients. + Lead daily… more
- Dignity Health (Bakersfield, CA)
- …Summary:** The Utilization Review LVN uses clinical judgement in providing utilization management services. The focus is to provide high quality ... Qualifications:** - Minimum 3-5 years of healthcare experience with general knowledge of Utilization Management and Managed Care. - Graduate of accredited school… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Stanford Health Care (Palo Alto, CA)
- …one of the Nation's most prestigious Cardiothoracic Surgery teams as an APP Leader. You will lead a team of APPs as well as have your own OR and Clinic time. We ... mission one patient at a time. **A Brief Overview** Provides supervision and management of advanced practice providers (APPs) in a distinct clinical service line.… more
- Trinity Health (Silver Spring, MD)
- …offs through clear and timely communication with third party payers of appropriate utilization ; to coordinate with the Physician Advisor, other members of the ... Documentation Quality team and Care Management staffs to support and evaluate utilization ...and perceiving our world and that these differences often lead to innovative solutions. Our dedication to diversity includes… more
- Catholic Health Services (Melville, NY)
- …and management ; contributes to completion of project status reports. Lead meetings with staff and/or leadership to assist in establishing project priorities ... a home health service, hospice and a network of physician practices across the island. At Catholic Health, our...and managing resources) and all phases of the project management life cycle for a variety of initiatives Actively… more
