- Humana (Lincoln, NE)
- …PHI / HIPAA information. **Preferred Qualifications** + BSN + 2 to 3 years of home health experience and/or utilization management experience + Experience in ... part of our caring community and help us put health first** The Utilization Management Nurse 2...work independently under general instructions and within a team. **Work-At- Home Requirements** + Must have the ability to provide… more
- CaroMont Health (Gastonia, NC)
- …of social work experience required. - Preferred: experience in case management, home health , quality/ utilization management, or hospital/community settings. ... of nursing experience required. - Preferred: experience in case management, home health , quality/ utilization management, or hospital/community settings.… more
- Elevance Health (TX)
- …patients, patients with IDD and patients with special needs is preferred. + Home Health , Utilization Management or Case Management experience strongly ... nursing and minimum of 2 years of condition specific clinical or home health /discharge planning experience; or any combination of education and experience, which… more
- CaroMont Health (Gastonia, NC)
- …At least 1 year's social work experience required. Experience in case management, home health , quality and/or utilization management, community or hospital ... 1 year social work experience required. Experience in case management, home health , quality and/or utilization management, community or hospital setting… more
- …advising subordinates as necessary. Resolving routine personnel problems. Authorize and review utilization of home health nursing, social work, occupational, ... quality and safety, is looking for a** **Clinical Nurse Manager** **to join our** ** Home Health ** **team!** **Why choose Baystate Homecare?** **Baystate Home … more
- Hackensack Meridian Health (Wall, NJ)
- …the health care team to ensure effective coordination, appropriate resource referral, and utilization of home health aide services. + Educate the patient ... healthcare and serve as a leader of positive change. At Hackensack Meridian Health at Home , we recognize our full- and part-time benefit eligible team members by… more
- CaroMont Health (Gastonia, NC)
- …preferred. Behavioral health experience preferred. Experience in case management, home health , quality and/or utilization management, community or ... not limited to, when applicable per patient needs: placement, durable medical equipment, home health , personal care services, and other complex care support… more
- Hackensack Meridian Health (Little Falls, NJ)
- …the health care team to ensure effective coordination, appropriate resource referral, and utilization of home health aide services. + Act as a ... Health (https://www.stjosephshealth.org/) , provides a comprehensive continuum of home health care and hospice services, support, and resources to patients… more
- Beth Israel Lahey Health (Burlington, MA)
- …Description:** The Inpatient Registered Nurse (RN) Case Manager for Hospital at Home Care Transitions coordinates utilization review, discharge planning and ... in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical...Lahey Hospital and Medical Center in Burlington Hospital at Home Program Full Time Days 8:00am-4:30pm Weekend and holiday… more
- Actalent (Sunrise, FL)
- Actalent is hiring a Utilization Management Nurse!Job Description The Utilization Management Nurse (UMN) plays a crucial role in reviewing service authorization ... requests to ensure appropriate service utilization . Working under the general supervision of the Director and/or Manager/Supervisor of Medical Management, and in… more
- Intermountain Health (Las Vegas, NV)
- …metrics. Leads the system-wide development of partnerships with payors to support Utilization Management. Collaborates with Castell, Home Care, Clinic Management ... **Job Description:** The Utilization Review Care Management Director is responsible for...reimbursement or eight years of professional progressive experience in health care delivery. Hold and maintain a professional license… more
- Intermountain Health (Las Vegas, NV)
- …+ Five years in a professional setting such as hospital, clinic, or home health environment. + Strong analytical and problem-solving skills. + Experienced ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- WellSpan Health (York, PA)
- …quality health care. Provides leadership in the integration of utilization management principles throughout the System. Responsible for screening patients for ... encompass more than 2,300 employed providers, 250 locations, nine award-winning hospitals, home care and a behavioral health organization serving central… more
- Sutter Health (Sacramento, CA)
- …Services (GR) Grouper (CMS) preferred. + Post-acute levels of care such as Home Health , Hospice, Advance Illness Management (AIM), and Palliative Care. Skilled ... the organization's goals and objectives for ensuring the effective, efficient utilization of health care services. The PA will develop expertise on matters… more
- The Cigna Group (Sacramento, CA)
- …Nurse Case Management assignments/projects. Plans, implements, and evaluates appropriate health care services in conjunction with the physician treatment plan. ... **Summary description of position:** + Plans, implements and evaluates appropriate health care services in conjunction with the physician treatment plan. +… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize hospital ... position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus!...by faith. Driven by innovation. Powered by humankindness. CHI Health , now part of CommonSpirit Health , is… more
- Tufts Medicine (Burlington, MA)
- …payment processing. In addition, this role focuses on performing the following Utilization duties: Ensures the delivery of clinical services is appropriate and ... medical necessity guidelines and submits supportive clinical documentation to patient's health insurers to ensure authorization for clinical services, etc. A… more
- Elevance Health (Buffalo, NY)
- …with, or knowledge of, the Medicaid population is preferred. + Experience with home health , Long Term Service and Support, specifically managing members with ... RN Utilization Management - Case Management (Medicaid Long Term...unrestricted RN license and/or certification to practice as a health professional within the scope of licensure in the… more
- Ascension Health (Wichita, KS)
- …career opportunities across a number of hospitals, clinics, therapy centers and home health services. Ascension is a leading non-profit, faith-based national ... **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs,...**Location:** Wichita Kansas **Benefits** Paid time off (PTO) Various health insurance options & wellness plans Retirement benefits including… more
- Centene Corporation (Austin, TX)
- …to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with ... million members as a clinical professional on our Medical Management/ Health Services team. Centene is a diversified, national organization...role have the flexibility to work remotely from their home anywhere in the Eastern or Central time zone,… more