- 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 ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We ... Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation...of care, care coordination, and other clinical and medical management programs. + Have working knowledge of… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …to patients, interrelationships of the care components, and their effective integration. + Knowledge of the models of case management , including the principles ... delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure...and practices of discharge planning, utilization review, and quality assurance/improvement. + Knowledge … more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Molina Healthcare (NV)
- …of illness and the site of service. ** KNOWLEDGE /SKILLS/ABILITIES** The Manager , Healthcare Services provides operational management and oversight of ... not a compact state at this time.** **Prior experience with managed care (Medicaid, Medicare) Utilization Management processes and 3 + years in management /… more
- Trinity Health (Silver Spring, MD)
- …setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years clinical ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible...in an acute healthcare setting. + Designation Changes and Utilization Review + Knowledge of pertinent regulatory,… more
- UCLA Health (Los Angeles, CA)
- …the next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management ... + Thorough knowledge of health care industry, utilization review, utilization management , and...off-site meetings and conferences + ACM - Accredited Case Manager preferred + CCM - Certified Case Manager… more
- AdventHealth (Altamonte Springs, FL)
- … will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of Utilization will provide support, ... RN on care management duties/assignments. The Senior Manager of Utilization will be responsible for...in a physician's office, clinical or hospital setting. . Knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF, and… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Guidelines (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) -… more
- Amazon (Seattle, WA)
- …to completion. We're seeking an experienced Senior Technical Infrastructure Program Manager in Seattle, WA to oversee data center electrical infrastructure ... projects. You will lead cross-functional and technical teams identify sub-optimal utilization , determine root causes, design solutions and drive project delivery.… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Catholic Health Initiatives (Lexington, KY)
- …in program planning, implementation, staff development, and needs assessment + Comprehensive knowledge of utilization management , financial management ... our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for...certification of any of the following: CCM (Certified Case Manager ), ACM (Accredited Case Manager ) required or… more
- Prime Healthcare (Montclair, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/175009/case- manager -%28rn%29 utilization - management ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS (AHA) certificate, preferred.5. Knowledge of Milliman… more
- Prime Healthcare (North Las Vegas, NV)
- …computer skills. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174491/case- manager -%28rn%29 utilization - management ... year experience in case management , discharge planning or nursing management , preferred.4. Current BCLS certificate, preferred.5. Knowledge of Milliman… more
- Healthfirst (NY)
- … management , identifying alternative care options, and discharge planning + Certified Case Manager + Interqual and/or Milliman knowledge + Knowledge of ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes:...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Sutter Health (Burlingame, CA)
- …delivery and case management within a managed care environment. Comprehensive knowledge of Utilization Review, levels of care, and observation status. ... **Organization:** Bay Administration **Position Overview:** Responsible for Utilization Management and accurate bed placement for patients coming in from the ED.… more
- Prime Healthcare (National City, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/174432/case- manager utilization - management ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Hartford HealthCare (Torrington, CT)
- …moment*. **Job:** **Professional Clinical* **Organization:** **Charlotte Hungerford Hospital* **Title:** * Utilization Review Social Work Care Manager (LCSW) - ... Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the...activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- LA Care Health Plan (Los Angeles, CA)
- … Knowledge of state, federal and regulatory requirements in Care/Case/ Utilization Management . Strong verbal and written communication skills. Computer ... Supervisor, Utilization Management RN Job Category: Clinical...Care's culturally diverse membership. The position supports the UM Manager /Director. This role also assists UM Educator/ Manager /Director… more
- Trinity Health (Mason City, IA)
- …nurse in the state of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the state of Iowa ... Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, insurance… more
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