- CenCal Health (Santa Barbara, CA)
- …for performing utilization management activities, which may include telephonic or onsite clinical reviews, care coordination, transitions of care , or ... value-based programs. Serve as a liaison to providers and CenCal employees regarding UM processes and operational standards. Review requests for referrals and… more
- UnitedHealth Group (San Antonio, TX)
- …DM, and MOC programs, monitoring policies and procedures, and preparation and review of clinical files. Delegated reporting functions include report preparation, ... Optum family of businesses, is seeking a Regulatory Adherence UM Health Plan Auditor to join our team in...team in San Antonio, TX. Optum is a clinician-led care organization that is changing the way clinicians work… more
- Sparrow Health System (Charlotte, MI)
- … that prescribes strategies to reach expected outcomes. Implements and coordinates care delivery among the clinical disciplines and documents those activities. ... MI Job Description General Purpose of Job : Provides direct nursing care for defined patient population. Delivers safe, cost-effective, patient-centered care … more
- University of Maryland Medical System (Towson, MD)
- …sources utilized and provides advanced reflections to staff regarding the impact to clinical care / patient's needs. Leads networking with external agencies based ... work. Analyzes department performance effectiveness & provides feedback about specialty care interventions across the healthcare system. Completes clinical chart… more
- University of Michigan (Ann Arbor, MI)
- …Patient Care Assure the appropriateness of medication therapy through: Review of medication orders for clinical appropriateness based on patient ... successful completion and submission of the following: Completed application via the UM Careers website Letter of Intent Updated curriculum vitae Mission Statement… more
- Regal Medical Group, Inc. (Northridge, CA)
- …of medical directors, nurses and coordinators, participate in the pre-service medical necessity review of patient care . Review prior authorization requests ... review , or medical director decision making. Perform retro-claims review for outpatient and inpatient. Working with UM...resource to the IPA providers on issues related to UM and other aspects of patient care .… more
- Health eCareers (Los Angeles, CA)
- …Responds proactively to escalation of care delays, particularly related to clinical care , physician decision making, and patient and family related discharge ... The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the...utilization of hospital resources and the quality of patient care . Assists the Case Management staff in resolving patient… more
- Molina Healthcare (Long Beach, CA)
- …other clinical programs. Collaborates with multidisciplinary teams to promote Molina Care Model. Adheres to UM policies and procedures. Occasional travel to ... Education Bachelor's Degree in Nursing Preferred Experience Previous experience in Hospital Acute Care , ER or ICU, Prior Auth, Utilization Review / Utilization… more
- University of Maryland Medical System (Towson, MD)
- …magazine. Job Description Schedule: 7am to 7pm (.9 FTE) Focus of clinical practice/ care delivery and on own learning. Uses/applies evidence-based practice, ... be contributing to a locally and nationally recognized institution. UM St. Joseph has been recognized by The Leapfrog...protocols, documentation, pathways, etc Involves patient and family in care ; follows model of care delivery guidelines.… more
- UnitedHealth Group (Grand Junction, CO)
- At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care . The work you do here ... of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable...Join us to start Caring. Connecting. Growing together. The Clinical Coordinator is responsible for processing all Behavioral Health… more
- University of Maryland Medical System (Upper Marlboro, MD)
- …effective outcomes. c. Develops and sustains an environment that supports excellence in clinical practice and patient care ; forecasts trends; functions as change ... e. Incorporates and/or assists staff to incorporate current research findings into clinical practice, care delivery and management systems. f. Participates in… more
- Elevance Health (Las Vegas, NV)
- …necessary quality behavioral healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract. Refers cases to Peer Reviewers ... Anticipated End Date: 2025-08-01 Position Title: Behavioral Health Care Manager II - Nevada Job Description: Position specific details: The successful candidate will… more
- Blue Cross and Blue Shield of Minnesota (St. Paul, MN)
- …business rules, regulatory guidelines and policies and procedures to determine clinical appropriateness. Completes review of both medical documentation and ... following corporate and divisional privacy policies. Accountable for timely and comprehensive review of clinical data with concise documentation, decisions and… more
- UNC HEALTH (Raleigh, NC)
- …to patients, clinical trials and provide the same quality of care found at nationally recognized healthcare systems without patients having to travel far ... through the integrating and functions of case management, utilization review and discharge planning. The Care Manager...as appropriate. As necessary meet with the Utilization Manager ( UM ) and SW after the meeting to discuss updates… more
- UnitedHealth Group (Austin, TX)
- …through close coordination with all network and provider contracting Regularly meet with Care Transitions' leadership to review care coordination issues, ... for the clinical case reviews, as needed Conduct provider telephonic review and discussion and share tools, information, and guidelines as they relate to… more
- University of Maryland Medical System (Bel Air, MD)
- …other health organizations to serve as a resource for health promotion and education. Today, UM UCH is the leading health care system and second largest private ... Company Description University of Maryland Upper Chesapeake Health ( UM UCH) offers the residents of northeastern Maryland...greater than 12 months experience. Provides and coordinates independent care to patients within a clinical specialty… more
- Veterans Health Administration (Seattle, WA)
- …will be given to current, permanent employees of the VA Puget Sound Health Care System. Videos Duties The Nurse Manager (NM) is a registered professional nurse who ... anticipating patient needs, fostering interdisciplinary collaboration to optimize patient care delivery, and supporting creative approaches to managing complex… more
- Community Hospital of Huntington Park (Huntington Park, CA)
- …knowledge of hospital emergency codes; always utilizes standard precautions in the clinical setting; safely manages the environment of care by demonstrating ... and implementation of case management policies and procedures, and coordination of care with other healthcare providers and community resources. The Manager of Case… more
- Kaiser Permanente (Pleasanton, CA)
- …Minimum three (3) years of home care experience or quality utilization review experience. Education Bachelors degree in clinical related field OR four (4) ... report development. Provides objective assessment of important aspects of patient care through ongoing chart review with pre-established criteria. Facilitates… more
- University of Maryland Medical System (Upper Marlboro, MD)
- …all nurses who have greater than 12 months experience. Provides and coordinates independent care to patients within a clinical specialty as a fully effective and ... an exhaustive list of all job duties performed by personnel so classified. Clinical Practice: Provides independent care to unit specific patient population;… more
