- Baptist Memorial (Meridian, MS)
- …Required: RN with 3 years of clinical experience Preferred/Desired: RN with Case Management or Utilization Review experience in a hospital or payer ... Overview RN Utilization Review Weekender Job Code: 22818...against standard criteria per payer guidelines + Prioritizes observation case review + Assists with level of… more
- Baptist Memorial (Memphis, TN)
- …Required Preferred/Desired RN with 3 years of clinical experience RN with Case Management or Utilization Review experience in a hospital or payer setting ... RN with 3 years of clinical experience RN with Case Management or Utilization Review experience in a hospital or payer setting Desired Licensure,… more
- HCA Healthcare (Nashville, TN)
- …background with 1-4 years of nursing experience required + 1-4 years of relevant case management / utilization review experience preferred + Registered ... **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an… more
- Actalent (Sunrise, FL)
- …equivalent education + Valid Florida Driver's License + Knowledge of case management and utilization review concepts + Familiarity with Florida Medicaid ... activities. Essential Skills + Clinical review + Utilization review + Utilization management + Interqual + Milliman Commercial Guidelines + Medicaid… more
- RWJBarnabas Health (Newark, NJ)
- …settings. Additionally, candidates must have at least 3 years of recent experience in Case Management , Utilization Review , or Discharge Planning, and ... leadership experience required. This role focuses on clinical resource management , utilization review , discharge planning,...federal guidelines and is accountable for case management outcomes as outlined in the Utilization … more
- The Cigna Group (Sacramento, CA)
- …in state where you reside. + 3 years' experience in case management or utilization review . **Preferred requirements:** + Bachelors/CCM preferred + ... + Manages approximately 12-15 direct reports who are directly responsible for inpatient case management and all associated performance requirements for Cigna. +… more
- Diversicare Healthcare Services & Diversicare Ther (Birmingham, AL)
- …service to the managed care plan. * The case manager provides center case management / utilization review and discharge planning to assure that ... Bachelor's degree or higher is preferred + Minimum of two (2) years of case management / utilization review experience + Minimum of one (1) year experience… more
- UNC Health Care (Eden, NC)
- …promote continuity of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. ... Details** Legal Employer: NCHEALTH Entity: UNC Rockingham Health Care Organization Unit: RHC Case Management Work Type: Full Time Standard Hours Per Week: 40.00… more
- Tenet Healthcare (Detroit, MI)
- …Establish goals and objectives that support overall strategic plans of the Case Management and Utilization Review strategy · Lead Group hospital Case ... Management model, staffing and skill mix, complex Case Management , and centralized utilization review · Participate in new hospital Director of … more
- Stanford Health Care (Palo Alto, CA)
- …**Required Knowledge, Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care ... employee evaluations, and program development for the Department of Social Work and Case Management . Additionally, this position serves as a resource for problem… more
- Seattle Children's (Seattle, WA)
- …caring for children with medical complexity Current or previous hospital case management or utilization review experience Current or previous case ... provides leadership, supervision, and oversight of day-to-day operations of the Case Management department. Serves as the central resource to the director to… more
- Covenant Health (Nashua, NH)
- …in-services are attended /documented. + Annual goals are achieved. + Attends pertinent case management / utilization review programs to maintain current ... medical necessity (whether based on initial or continuing stay review ) to determine whether a level of care change...Minimum of five years broad clinical experience preferred + Case management and/or Utilization … more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management , care transition, collaboration with ... years of inpatient experience in a hospital environment preferred. + Previous case management , utilization review , and discharge planning experience… more
- HCA Healthcare (Lake City, FL)
- …We want your knowledge and expertise! **Job Summary and Qualifications** Provides hospital case management / utilization review and discharge planning to ... in case management and/or supervisory/ management position involving case management / utilization review /responsibility in an acute care… more
- Trinity Health (Fresno, CA)
- …Heart Association (AHA) Healthcare Provider CPR card is required. 7. Experience with case management , utilization review , and/or discharge planning ... Shift **Description:** This position is responsible for assisting the Care Coordinator with utilization review management and discharge planning tasks. This… more
- McLaren Health Care (Mount Clemens, MI)
- …_Preferred:_ * Associate degree in healthcare-related field * Two years of case management or utilization review experience * Three years of recent ... **Department:** MAC Case Management **Hours per pay period:**...patients, colleagues and community. 5. Performs concurrent and retrospective utilization management -related activities and functions to ensure… more
- McLaren Health Care (Port Huron, MI)
- …+ Associates degree in healthcare related field. + Two years of case management or utilization review experience * Three years of recent experience ... timeframes. 2. Ability to understand, interpret, explain, and use data for case management activities. 3. Ability to work with diverse teams and individuals,… more
- Prime Healthcare (Inglewood, CA)
- …supervision to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization ... experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/director-of- case - management utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306)… more
- Banner Health (Phoenix, AZ)
- …and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through the ... regulatory requirements. 6. Educates internal members of the health care team on case management and managed care concepts. Facilitates integration of concepts… more
- Ochsner Health (New Orleans, LA)
- …- 3 years of hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered ... plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management ...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more