- Excellus BlueCross BlueShield (Rochester, NY)
- …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- Commonwealth Care Alliance (Boston, MA)
- …& Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Utilization Management (Authorization) Unit is primarily responsible for the ... under the provisions of CCA's benefits plan. The Manager, Utilization Management is responsible for overseeing and...* Act as liaison with medical director, provider relations, case management and quality teams to support… more
- Houston Methodist (The Woodlands, TX)
- …and eligibility for state, local, and federal programs + Progressive knowledge of utilization management , case management , performance improvement, and ... At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed...coverage determinations (LCDs & NCDs). This position collaborates with case management in the development and implementation… more
- Humana (Charleston, WV)
- …Qualifications** + Bachelor's degree in nursing (BSN) + Previous experience in discharge planning, utilization management or case management a plus + ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...work may be required on a rotational basis; some travel to home office may be required. **Required Education… more
- Phoenix House (Wainscott, NY)
- ** Utilization Review Manager** **Job Details** **Job Location** East Hampton Residential - Wainscott, NY **Position Type** Full Time **Education Level** Graduate ... Degree **Salary Range** $80000.00 - $90000.00 Salary/year ** Travel Percentage** Up to 25% **Job Shift** Morning **Job Category** Nonprofit - Social Services… more
- Amergis (Canton, MA)
- …sameto facility wide personnel. + Demonstrated understanding of external agencyinterface with Utilization Review, Case Management , Patient Safety and ... be adding Admissions and Insurance Authorizations. MUST have experiencewith Utilization Review, Authorizations and Admissions. Position Details: + Location: Canton,… more
- Houston Methodist (Sugar Land, TX)
- …(MSW) + Master's in nursing preferred **WORK EXPERIENCE** + Five years experience in inpatient case management , social work or utilization management or ... to ensure operational effectiveness and efficiency of admission, concurrent and retrospective utilization management and medical claims functions to meet and… more
- Houston Methodist (Houston, TX)
- …Mgmt Social Svcs position is responsible for strategy, function and operations of the Case Management & Social Work department. This position is an integrated, ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
- Guthrie (Troy, PA)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...as necessary in the performance of this position. + Travel for this position is sometimes required. + Participation… more
- Genesis Healthcare (York, PA)
- …Five to seven years of clinical nursing experience is required. Prior experience in utilization review, case management or discharge planning is required. ... a meaningful impact in the communities we serve. Responsibilities The Manager, Case Management is responsible for the clinical, administrative, and financial… more
- Highmark Health (Dover, DE)
- …and is accountable for the oversight development and maintenance of the department's case management processes. This includes utilization management , ... the corporation to resolve issues and to ensure activities coincide with case management processes. Supports an interdisciplinary approach to meeting members'… more
- HCA Healthcare (Henderson, NV)
- …+ Lead centralized case management function, including Clinical Case Management , Utilization Review Services, and Clinical Documentation Improvement. ... HCA established policies, practices, efficiencies; and effectiveness of clinical Case Management , Utilization Management...preferred + The job may require up to 50% travel Knowledge, Skills Abilities & Behaviors: + Lead centralized… more
- Houston Methodist (Baytown, TX)
- At Houston Methodist, the Case Management Representative position is responsible for providing clerical assistance and data management support to the case ... management and social work department to facilitate efficient utilization of resources and discharge planning including referrals ...administrative duties of a higher complexity in support of Case Management operations. In addition, the CM… more
- HCA Healthcare (Nashville, TN)
- …+ 4+ years of experience in acute care preferred + 3+ years of experience in Case Management preferred + Occasional Travel : The job may require travel ... Do you want to join an organization that invests in you as a Case Management Operations Manager? At HCA Healthcare, you come first. HCA Healthcare… more
- ChenMed (North Miami Beach, FL)
- …of 2 years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management , home health, hospital discharge planning ... + Directs referrals to preferred providers. + Coordinates the integration of social services/ case management functions in the pre-acute, ER, acute and post-acute… more
- CVS Health (Dallas, TX)
- …we do it all with heart, each and every day. **Position Summary** **Texas Case Management Coordinator** Schedule is Monday-Friday, standard business hours Local ... to our members. Health service strategies, policies, and programs are comprised of utilization management , quality management , network management ,… more
- LifePoint Health (Rutherfordton, NC)
- …services within the case managed population. Educates Physicians and staff in Case Management standards and assists them in meeting the regulations and ... of care as necessary. Educates Physicians and staff in Case Management standards and assists them in...1st Level Review using McKesson InterQual Criteria to perform utilization management and quality screening for assigned… more
- Amergis (Carson City, NV)
- …+ Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, ... Salary: $3046 / Week The RN Case Manager is responsible for coordinating continuum of...of care activities for assigned patients and ensuring optimum utilization of resources, service delivery, and compliance with medical… more
- ChenMed (St. Louis, MO)
- …of 2 years' clinical work experience required + A minimum of 1 year of utilization review and/or case management , home health, discharge planning experience ... by either the RN or LPN include: + Conducts utilization view for appropriate utilization of services...required + A minimum of 1 year of case management experience in acute case… more
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