- Alameda Health System (Oakland, CA)
- …Required Experience : Three years of utilization review experience. Health insurance company and/or acute care hospital, post - acute and psych; three ... trends, and optimizing resource utilization. This role supports patient care coordination, fosters physician collaboration, and aligns with organizational objectives… more
- MVP Health Care (Tarrytown, NY)
- …guidelines. + Support and assess discharge planning efforts to ensure continuity of care and appropriate post - acute services. + Collaborate with providers, ... with Medicare guidelines and documentation standards preferred + Strong knowledge of sub- acute care , rehabilitation, and skilled nursing services + Proficiency… more
- Sharp HealthCare (San Diego, CA)
- …an accredited Licensed Vocational Nurse (LVN) program + 3 Years experience in the acute patient care and/or SNF setting. + California Licensed Vocational Nurse ... + Demonstrates knowledge of department policies and proceduresAuthorizes appropriate care levels, ie sub- acute , short term SNF...authorization as needed for DME or other services for post skilled nursing facility placement or home care… more
- Humana (Little Rock, AR)
- … care management. The clinical scenarios predominantly arise from inpatient or post - acute care environments. Has discussions with external physicians by ... Sun, Mon)** + 5+ years of direct clinical patient care experience post residency or fellowship, which...management, case management, discharge planning and/or home health or post acute services such as inpatient rehabilitation.… more
- CenterWell (Boston, MA)
- … facilitation with hospitals. The clinical scenarios predominantly arise from inpatient or post - acute care environments. There are discussions with external ... Qualifications** + MD or DO degree. + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes some experience… more
- LA Care Health Plan (Los Angeles, CA)
- …Provides the primary clinical point of contact for inpatient acute care hospitals requesting Inpatient care / post -stabilization admission requests, Higher ... within regular timelines. Reviews clinical data in real-time and post admission to issue a determination based on clinical... care (inpatient vs. observation) admission in the acute setting. Works with UM leadership, including… more
- Sutter Health (Oakland, CA)
- …Processing Service (PPS),Centers for Medicare and Medicaid Services (GR) Grouper (CMS) preferred. + Post - acute levels of care such as Home Health, Hospice, ... medical staff, including house staff, and all utilization management ( UM ) personnel, Care Management (CM) personnel to... Care . Skilled Nursing Facility (SNF), Long Term Acute Care (LTAC), B&C, Sub- acute ,… more
- University of Michigan (Ann Arbor, MI)
- …**Organizational Relationships** + Reports to the Associate Chief Nursing Officer (ACNO) for Primary Care and Post Acute + Partners with the Medical Director ... of care management and social work across adult and pediatric inpatient, ambulatory, post - acute care settings and emergency room. + Implement and sustain… more
- Dignity Health (Sacramento, CA)
- …engaging other relevant health team members, the patient and/or patient representative, and post - acute care providers in accordance with the patient's ... with utilization management, nursing, physicians, ancillary departments, insurers, and post - acute service providers to progress the care toward optimal… more
- Dignity Health (Gilbert, AZ)
- …plan, engaging other relevant health team members, the patient and/or patient representative and post acute care providers in accordance with the patients ... nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care ...Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification Training: + Knowledge of managed care… more
- Integra Partners (Troy, MI)
- Integra is looking for a LPN/LVN experienced in the managed care payor environment to perform pre-service and post -service utilization reviews and appeals for ... but are not limited to: + Perform pre-service and post service UM authorization reviews utilizing federal...or outpatient setting + Minimum of 2 years of UM experience in a managed care , payor… more
- Virginia Mason Franciscan Health (Silverdale, WA)
- …plan, engaging other relevant health team members, the patient and/or patient representative and post acute care providers in accordance with the patients ... utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes… more
- Nuvance Health (Danbury, CT)
- …progress, verifying continued need for services, and facilitating timely discharge planning. * * Post - Acute Care Coordination:* Collaborate with post - ... ensure CMS and regulatory compliance.* *Develop and maintain a UM plan to guide the team with detailed processes...connect patients with appropriate community resources, support services, and post - acute care options. Address barriers… more
- Trinity Health (Rensselaer, NY)
- …5 years in healthcare environment, including health plans, hospitals, ambulatory or post - acute care required. 5 years of progressively responsible ... and operational leadership and is responsible to coordinate inpatient care coordination (CM) and utilization management ( UM )...expert-level working knowledge of principles, practices, and operations in post - acute as well as acute … more
- Corewell Health (Royal Oak, MI)
- …Routinely communicates with payers, patients/family caregivers, physicians, the interdisciplinary team, post - acute and community-based care providers to ... and communication to patients/families regarding coverage for hospital and post - acute services, in accordance with CMS regulations....of relevant experience Minimum two years' experience in the acute care setting. Required + 3 years… more
- Molina Healthcare (Louisville, KY)
- …outpatient and inpatient services for the OH Medicaid behavioral health population. Strong post - acute level of care experience (Nursing Facilities, Acute ... health care experience, including experience in behavioral health and/or hospital acute care , or equivalent combination of relevant education and experience.… more
- Dignity Health (Los Angeles, CA)
- …utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes ... Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred + Knowledge of managed care...Health - California Hospital Medical Center is a 318-bed, acute care , nonprofit hospital located in downtown… more
- Catholic Health Initiatives (Chattanooga, TN)
- …utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes ... offer a comprehensive continuum of care , from preventative and primary care to acute hospital services specializing in cancer, cardiac, neuroscience, stroke,… more
- Cedars-Sinai (Beverly Hills, CA)
- …willing to obtain within 2 years time from start date **Experience:** + 2 years in acute care nursing - Medical Surgical/Tele/ICU/LTACH or 1 year in acute ... care personnel to ensure that the patient receives care timely post discharge. + Secures outpatient...nursing (Medical Surgical/Tele/ICU) with 2 or more year of care management experience ( UM or DC Planning).… more
- CommonSpirit Health (Lakewood, CO)
- …utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes ... with resources to help you flourish and leaders who care about your success. The RN Care ...of Employment required + Minimum two (2) years of acute hospital clinical experience or a Master's degree in… more
