- Trinity Health (Silver Spring, MD)
- …the activities of RN Case Managers for in inpatient care coordination and utilization review . Oversees interactions of staff with outside activities and agencies ... Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** Manager Care Mgt & Util Review **Employment...required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At… more
- The Mount Sinai Health System (New York, NY)
- **JOB DESCRIPTION** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program ... medical records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …development, and leadership programs + And more **Description** We're seeking an **Assistant Manager , Utilization Review ** , responsible for supervising and ... coordinating activities of personnel in the Utilization Review Department, including: + Staff schedules...least 3 years of healthcare experience required. + Case Management certification (CCM or ACM) preferred. + Leadership experience… more
- Hartford HealthCare (Torrington, CT)
- …*your moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Trinity Health (Mason City, IA)
- …**Hours:** Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, ... nurse in the state of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the state of Iowa… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...ie MCG ) b. Supports & Participates in pre-admission review , utilization management , and concurrent… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager...participation in and follow up of Utilization Management audits, such as readiness review , Data ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- Billings Clinic (Billings, MT)
- …Starting Wage DOE: $35.34 - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is to conduct initial, ... prior to starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic (Billings Clinic… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION REVIEW + Reviews prospectively, concurrently and retrospectively… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/171837/case- manager %2c-rn utilization - review ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review Full Time Days - 2406003414 Description : The Detroit Medical Center (DMC) is a nationally recognized health care system that serves ... for case management scope of services including: Utilization Management services supporting medical necessity and...level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …utilization of resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of ... patient caseload. Collaborates with the attending LIP, Clinical Case Manager , nurse, and other members of the treatment team,...to the treatment team, Director of Utilization Management , and the Medical Director. + Review … more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Cedars-Sinai (Los Angeles, CA)
- …named us one of America's Best Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's placement to be at ... follows the UR process as defined in the Utilization Review Plan in accordance with the...continued employment. **Req ID** : 4300 **Working Title** : Utilization Management Case Manager -… more
- Molina Healthcare (NV)
- …integrated) performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical ... not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management /… more
- Huron Consulting Group (Chicago, IL)
- …accurate and detailed records of review decisions and interactions in the utilization management system. + Generate and analyze reports on utilization ... you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring...and conduct daily Staff Huddles for operations and priorities review . + Lead Patient Care Management Escalation… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... HMO environment + Thorough knowledge of health care industry, utilization review , utilization management...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- BayCare Health System (Cotton Plant, AR)
- …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +...+ Required RN (Registered Nurse) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager ) **Education:**… more
- AdventHealth (Altamonte Springs, FL)
- …. Develops and implements case management programs and education, including utilization review , transitions of care, disease management , population ... ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of Utilization will provide support, training and… more