- Beth Israel Lahey Health (Burlington, MA)
- …just taking a job, you're making a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse **Job Description:** The Inpatient ... determine appropriateness for inpatient and outpatient care. 3) Utilizes clinical expertise to determine the appropriate level of care...effectively with medical and hospital staffs. - Case Manager experience as well as Utilization Review… more
- Trinity Health (Silver Spring, MD)
- **Employment Type:** Full time **Shift:** Day Shift **Description:** **Job Title:** RN Case Manager - Utilization Management **Employment Type:** Full Time ... **Location** : Holy Cross Hospital **Position Purpose:** As a Case Manager in Utilization Management,...and payers, and streamline care plans to align with clinical and regulatory standards. By optimizing resource utilization… more
- Scottish Rite for Children (Dallas, TX)
- …one priority! We're committed to giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - ... effective communication with patient care team members related to utilization management + Verify medical necessity of all Inpatients...years of precertification experience + Certified Case Manager , preferred + 3-5 years of clinical … more
- Helio Health Inc. (Syracuse, NY)
- …efforts to track, review, and analyze data relating to continuous quality improvement. The Utilization Case Manager will work on a Full-Timebasis supporting ... position and also take into account information provided by the hiring manager and program Job LocationsUS-NY-Syracuse Category Case /Care Management Position… more
- Dartmouth Health (White River Junction, VT)
- Utilization Review Case Manager ...models, and patient satisfaction to guide patient care and utilization . * Completes clinical review of referrals ... – Home Health PRN, Days Why work as a Utilization Review Case Manager at...you need. Benefits include: * Employee Referral Bonuses * Clinical CEUs * Online LinkedIn Learning Schedule: * Monday… more
- Prime Healthcare (Lynwood, CA)
- …school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least ... experience, education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209331/ case - manager %2c-rn utilization -review/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Francis… more
- Prime Healthcare (Montclair, CA)
- …school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least ... education, credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/208989/ case - manager -%28rn%29 utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityMontclair… more
- Prime Healthcare (Weslaco, TX)
- …Criteria preferred. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/210205/registered-nurse- case - manager utilization ... designed to facilitate and insure the achievement of quality, clinical and cost effective outcomes and to perform a...a related field. At least one year experience in case management, discharge planning or nursing management;2. CCM or… more
- Sharp HealthCare (San Diego, CA)
- …maintaining quality and cost effective care for patients throughout the continuum. The Clinical Case Manager facilitates and coordinates services with health ... towards the achievement of quality and cost outcomes. The Clinical Case Manager is responsible...intervention, follow up and evaluation of care pertinent to utilization and financial information. + Utilization ManagementMaintains… 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 ... nurse to join our dynamic team as an RN Utilization Manager . Role is full time, 40...of patient data and treatments. Communicates daily with the Case Manager to manage level of care… more
- LifePoint Health (Rutherfordton, NC)
- …**Job:** **Please select a valid job field* **Organization:** ** **Title:** * Clinical Case Manager * **Location:** *NC-Rutherfordton* **Requisition ID:** ... hospital by facilitating initiation of care starting.2. The ED Case Manager starts initiation and utilization...as indicated.13. Discusses payer criteria and issues on a case -by- case basis with clinical staff… more
- Tufts Medicine (Burlington, MA)
- …and payment processing. In addition, this role focuses on performing the following Utilization duties: Ensures the delivery of clinical services is appropriate ... assisting with the coordination of the Utilization Management Committee. The Utilization Management Operations Manager follows the system's Utilization … more
- Commonwealth Care Alliance (Boston, MA)
- …procedures, and facilities under the provisions of CCA's benefits plan. The Manager , Utilization Management is responsible for overseeing and managing the ... of service decisions and organizational determinations. Essential Duties & Responsibilities: The Manager , Utilization Management reports to the Director of … more
- Beth Israel Lahey Health (Burlington, MA)
- …care experience, including experience in a leadership role. Two years of case management or utilization management experience desirable. **Key Relationships:** ... Coding & UR: Receives direction regarding priorities, assignment, coordination and outcome. Clinical Leaders: Receives direction and training from Case Managers:… more
- The Cigna Group (Sacramento, CA)
- …**Job Description** **Position Scope:** + Manages/Coordinates an active caseload of inpatient case management cases for Cigna. + Uses clinical knowledge to ... Description Summary** Provides advanced professional input to complex Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health… more
- CVS Health (Charleston, WV)
- …impact functionality and the member's restrictions and limitations. + Analyzes utilization , self-report and clinical data available to consolidate information ... and every day. Travel: _Up to 25%_ The Care Manager BH is responsible for driving and supporting care...or outpatient clinic/facility + Crisis intervention skills + Managed care/ utilization review experience preferred + Case management… more
- Sharp HealthCare (San Diego, CA)
- …other requirements for the position, and employer business practices. **What You Will Do** The Clinical Case Manager 's (CCM) role is to be a patient advocate ... options for patients and are provided excellent care. The Clinical Case Manager will be...community service data for at high risk persons for under- utilization of oncology health services. + Implements Plan of… more
- CVS Health (Lawton, OK)
- …appropriate treatment/services. + Applies and interprets applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, ... knowledgably participate with their provider in healthcare decision-making. + Analyzes utilization , self-report and clinical data available to consolidate… more
- Healthfirst (IA)
- …across a variety of treatment settings for high risk, complex populations + Certified Case Manager + Interqual, Milliman, and/or TruCare knowledge + Knowledge of ... and reviews medical charts to obtain additional information required for appropriate utilization management and to solve complex clinical problems + Allocate,… more
- CVS Health (Springfield, IL)
- …as needed/requested by Management. Preference for candidates residing in the Chicago area. Clinical Case Manager RN is responsible for telephonically and/or ... of Care: - Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and… more
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