- Commonwealth Care Alliance (Springfield, MA)
- …care management and care delivery. Within the CIC Program, the Community Health Worker (CHW) functions as an integral member of an interdisciplinary team for care ... to influence the outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment and closing gaps in care through connecting patients… more
- Providence Little Company of Mary Medical Center - San Pedro (San Pedro, CA)
- …to perform discharge planning and utilize interqual criteria - Experience in utilization review and concurrent reviews Description: This position requires ... Specialty Case Manager Job ID 33531206 Job Title Registered Nurse - Case Manager @ Providence Little Company of...must be able to perform retrospective reviews and manage worker 's compensation cases. Understanding of coding and billing, including… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... team. Works closely with the Case Managers and Social Workers on the units and reviews findings with them....cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- Commonwealth Care Alliance (Springfield, MA)
- …influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for behavioral health needs, and closing quality ... Timely Psychiatric post hospital discharge with focus on hospitalization and utilization reduction + Facilitating and/or delivering preventative care and behavioral… more
- Lawrence General Hospital (Lawrence, MA)
- …and facilitates appropriate discharge plans. + Works in conjunction with Utilization Review Nurse , Social Worker and Clinical Care Leader to ensure ... an acute care setting with discharge planning, continuing care, care management, and utilization review . + Five years clinical nursing experience required +… more
- Ochsner Health (New Orleans, LA)
- …hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license in ... implement discharge plans based on patient's individualized needs. Registered Nurse (RN) Case Manager - Case Management OMC Jefferson...of the conditions of participation as it relates to utilization review and discharge planning. + Maintains… more
- Centene Corporation (San Diego, CA)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... or Remote - TX** **Position Purpose:** Performs a clinical review and assesses care related to mental health and...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Centene Corporation (Nashville, TN)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... benefits including a fresh perspective on workplace flexibility. Remote position **Registered Nurse (RN) or licensed clinician only. 2-4 years of behavioral health … more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Workers ' Compensation. The ... and the evaluation of coverage under the Plan. The Nurse Case Manager reports to the Casualty Department Manager....for timely return to work. + Provides case management, utilization review , continued stay reviews, and based… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/228577/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum… more
- PeaceHealth (Eugene, OR)
- **Description** PeaceHealth is seeking a RN Admissions Coordinator/ Utilization Review - Psychiatric Unit for a Per Diem/Relief, 0.00 FTE, Variable position. The ... with patients, families, referring facilities, physicians, emergency departments' crisis workers , public safety officers, outside agencies and Behavioral Health… more
- Centene Corporation (Phoenix, AZ)
- …and be licensed in Arizona **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... of BH utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- Molina Healthcare (GA)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family… more
- Prime Healthcare (Inglewood, CA)
- …managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally, ... to lead our dynamic Case Management Team consisting of Registered Nurses, Social Workers , and Clinical Coordinators. This leader will oversee all facets of … more
- Molina Healthcare (GA)
- … Nurse (RN), Licensed Vocational Nurse (LVN), Licensed Practical Nurse (LPN), Licensed Clinical Social Worker (LCSW), Licensed Marriage and Family ... services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team… more
- CDPHP (Latham, NY)
- …values and invites you to be a part of that experience. The BH Utilization Specialist is responsible for coordination of care for CDPHP members across the continuum, ... discharged from an acute or subacute level of care. The BH Utilization Specialist will conduct telephonic care coordination activities with members, their loved… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- ChenMed (Cincinnati, OH)
- …expanding and we need great people to join our team. The Community Social Worker overall goal is to help people who have chronic, life threatening or altering ... family situations. Additional duties and responsibilities include working closely with the nurse case managers to transition patients to the appropriate level of… more
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