- Marion County (Salem, OR)
- …staff regarding care recommendations, diversion opportunities, and Long-Term Psychiatric Care needs. With clinical supervisor acting as CMHP delegate, ... initiate authorization process for requests for Long-Term Psychiatric Care .Ensure accuracy of utilization data of those admitted to the Oregon State Hospital and… more
- Marion County (Salem, OR)
- …to the following Program Development & ManagementProvide program development and management /oversight of a diverse group of programs and teams. Program oversight ... objectives of the programs, to ensure high-quality service delivery.Develop performance management systems and set metric benchmarks to ensure accountability and… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Manager of Case Management . **Responsibilities** A day in the life of Supervisor Care Management at Hackensack Meridian Health includes: + Leadership ... practice standards, and regulatory/payor requirements. The role integrates and coordinates utilization management , care coordination, discharge planning… more
- LA Care Health Plan (Los Angeles, CA)
- …work/licensure. The Supervisor is a subject matter expert (SME) in Care /Case/ Utilization Management and supporting regulations, policies, protocols, and ... Supervisor , Utilization Management RN... Supervisor , Utilization Management RN Job Category: Clinical...care experience. Minimum of 2 years experience in Case/ Care / Utilization Management in an acute… more
- Commonwealth Care Alliance (Boston, MA)
- …policies and procedures. - Provide high quality comprehensive documentation in the care management platform to reflect the accurate data entry required ... management and leadership with the development, refinement and enhancement of utilization management workflows, policies and procedures. + Participate in… more
- Centene Corporation (Salem, OR)
- …to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. **(Location must reside in Oregon)** + Monitors and ... and efficiency standards + Collaborates with utilization management team to resolve complex care member...utilization management team to resolve complex care member issues + Maintains knowledge of regulations, accreditation… more
- Universal Health Services (San Antonio, TX)
- Responsibilities Position Summary : The Utilization Management Supervisor is responsible for planning, organizing, and managing daily operations of the ... Utilization Management team. The Supervisor ...Utilization Management team. The Supervisor duties include but...in a mental health setting with previous experience in Utilization Management / Care Management … more
- Prime Care Coordination (Webster, NY)
- …of those services, with the purpose of controlling costs and monitoring quality of care . The Utilization Management Reviewer will play a key role ... Summary: Utilization Management Reviewer (UR) is the...(PHI) and financial information + Identify suspected Quality of Care , risk, and utilization issues discovered during… more
- UCLA Health (Los Angeles, CA)
- …Advantage team, you will be responsible for assisting with the day-to-day management of the UM department and coordinators. This will involve coordinating staff ... staff in a healthcare environment + Two or more years of managed care or health plan experience preferred + Experience processing ambulatory commercial, Medicare Fee… more
- Hartford HealthCare (Wethersfield, CT)
- …_* The Clinical Resource Management Associate is an integral part of the Care Management team. The Clinical Resource Management Associate's focus is on ... programs and other common practices across the system. Integrated Care Partners (ICP) is a physician-led, clinically integrated health...providing support and coordination of utilization management services for the … more
- WelbeHealth (Los Angeles, CA)
- …By guiding this team, the Utilization Management RN Supervisor drives the continuous improvement of our care delivery processes. **Essential ... At WelbeHealth, we are transforming the reality of senior care by providing an all-inclusive healthcare option to the...a critical role in our participant's journey and our Utilization Management team ensures we can provide… more
- Billings Clinic (Billings, MT)
- …here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE ... Rule, or payer authorization for status and level of care *Priority 2: Performs Utilization Review (UR)...Physician Advisor, per department process or procedure *Insurance and Utilization Management *Maintains working knowledge of CMS… more
- BayCare Health System (Cotton Plant, AR)
- … Care or Emergency Service **Facility:** BayCare Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant** **Status:** **Part Time, Exempt: ... area. Our network consists of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.… more
- CVS Health (Raleigh, NC)
- …of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our brand - with heart at ... accelerating our ability to innovate and deliver solutions to make health care more personal, convenient and affordable. Position Summary Must reside within… more
- CVS Health (Tallahassee, FL)
- …working in community based mental health service like Targeted Care Management , Psychosocial Rehabilitation, or related utilization management experience ... purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in our...UM clinician will work in conjunction with the Clinical Supervisor and Medical Directors to facilitate optimal care… more
- Amity Foundation (Tucson, AZ)
- …individual is responsible for performing a variety of concurrent and retrospective utilization management -related reviews and functions and for ensuring that ... to teach, learn and join our community as a Utilization Review Specialist at our campus in Tucson, AZ....for more information. + Conducting and Completing Level of Care interviews for new enrolling students. Creating and documenting… more
- Highmark Health (Pittsburgh, PA)
- … review/ management + 1 year as a supervisor or manager of Utilization /Case Management with a Managed Care Organization + 1 year in prior ... customers of Helion's technology platform(s). **ESSENTIAL RESPONSIBILITIES** + Perform management responsibilities to include, but are not limited to: involved… more
- Geisinger (Danville, PA)
- …(status) to reflect congruence with clinical condition, physician intent, and utilization review outcomes with current rules and regulatory requirements. Job Duties ... + Creates plan for care across the continuum, integrating patient and family preferences...and removal of barriers. + Maintains ongoing dialog with supervisor and other health providers to ensure effective implementation… more
- Sharp HealthCare (San Diego, CA)
- …of programs and services consistent with the mission of the Integrated Care Management Division. Responsible for supporting the strategic plan, business ... growth, and quality improvement plans for the education program for the Integrated Care Management (ICM) service line. Collaborates regularly with other hospital… more
- Hackensack Meridian Health (Edison, NJ)
- **Overview** The role integrates and coordinates utilization management , care coordination, discharge planning functions and performance improvement ... activities for all care managers. The Supervisor , Care Management is accountable...setting. + Familiar with hospital resources, community resources, and/or resource/ utilization management . + Care coordination,… more
