- Surgery Partners (Altoona, WI)
- …agencies while ensuring physician and nurse documentation meet set standards Understand utilization review / case management rules and guidelines to ensure ... APPLICATION DEADLINE: 07/26/2025 Job Summary: The Registered Nurse - Utilization Review oversees and coordinates utilization...Per Week - Day Shift Essential Job Functions: The Case Manager conducts medical record reviews using… more
- Connecticut Children's (Hartford, CT)
- …Knowledge of pediatric growth and development 0-21 yrs. Demonstrates current knowledge of Nurse Case Manager , Utilization Review Nurse, and Social Work ... guidance from the nurse case managers, social workers and utilization review nurses. The CMA provides broad scale administrative, project, and operations… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered ... (CCM, ACM, CCM-RN) preferred. Proven leadership experience in acute care, utilization review , case management. Strong working knowledge of hospital billing,… more
- Vensure Employer Services (Dallas, TX)
- …Minimum of 3-5 years of hospital case management, discharge planning, or utilization review experience required. Experience in acute care or ICU case ... while working in a supportive and patient-focused environment. Position Summary The Case Manager is responsible for facilitating effective and efficient patient… more
- CVS Health (Dallas, TX)
- …Assessment of Members: Through the use of care management tools and information/data review , the Case Manager conducts comprehensive evaluation of referred ... assessment, clinical writing and communication skills are required. The Case Manager is responsible for conducting face...barriers to meet goals and objectives. Presents cases at case conferences to obtain multidisciplinary review in… more
- Corvel (Madison, WI)
- …hiring a caring, self-motivated, energetic and independent registered nurse to fill a Medical Case Manager position in Wisconsin. Work from home, and on the ... Monday - Friday, regular business hours. As a Medical Case Manager you will make a meaningful...advisors/clients and coworkers. A cost containment background, such as utilization review or managed care is helpful.… more
- Premier Health (Eaton, OH)
- Case Manager FACILITY: SAMARITAN BEHAVIORAL HEALTH Case Manager functions as a member of a team to assist in the planning, development, and delivery of ... clients and uses that knowledge to coordinate services and advocate for identified clients. Case Manager acts as a resource consultant to other team members and… more
- CVS Health (Downers Grove, IL)
- …Preferred: * Case management and discharge planning experience *Managed care/ utilization review experience *Crisis intervention skills Education *Minimum of ... of network management, clinical coverage, and policies. Position Summary/Mission Our Case Managers use a collaborative process of assessment, planning, facilitation,… more
- Mount Sinai Hospital (New York, NY)
- …homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager or a minimum of 3-5 years experience ... Job Description RN/ Case Manager MSH Case ...a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case… more
- RiverWoods Behavioral Health (Riverdale, GA)
- …patient population served by the facility preferred. Previous experience in case management and/or utilization review preferred. ... to clients/patients/residents. Responsibilities ESSENTIAL FUNCTIONS: Acts as the primary case manager /discharge planner including the provision of: daily… more
- Northwell Health (Staten Island, NY)
- … management and clinical pathways, variance analysis and trending, quality management/ utilization review and home care/discharge planning, preferred. Keeps ... another level of care according to regulatory standards. * Performs concurrent utilization management using Interqual criteria. Conducts chart review for… more
- AHMC Healthcare (San Gabriel, CA)
- …organizing, controlling, and directing all services and operations in the areas of Utilization Review and Discharge Planning. With primary focus of this role ... hires and vacancies levels are appropriate. *Reviews all Quality Assurance referrals from Case Managers and refers cases for peer review . *Accountable for the… more
- Integrated Home (Hollywood, FL)
- …Clinical Review Manager is responsible for overseeing the clinical review and management of utilization management (UM) program related to home health ... ensure accuracy of medical necessity decisions. The Senior Clinical Review Manager will lead a team of...license required. Minimum of 3-5 years of experience in utilization management, case management, or a related… more
- Corvel (Rancho Cucamonga, CA)
- The Telephonic Case Manager coordinates resources and creates flexible, cost-effective options for ill or injured individuals on a case -by- case basis to ... quality individualized treatment goals, including timely return-to-work if appropriate. The Telephonic Case Manager will rely on their medical knowledge to… more
- UnitedHealth Group (Oxford, PA)
- …culture of performance that's driving the health care industry forward. As a Field Case Manager RN with UnitedHealth Group, you'll support a diverse member ... PA Access to reliable transportation Preferred Qualifications: BSN Certified Case Manager (CCM) Case management... management experience Experience in discharge planning Experience in utilization review , concurrent review or… more
- Kings View Corporation (Fresno, CA)
- …services to the underserved community, is currently seeking a driven Clinical Supervisor- Utilization Review to join our mission to provide compassionate services ... with integrity while listening and responding to the community in need. Clinical Supervisor- Utilization Review (280) Fresno, CA The Clinical Supervisor is part… more
- Casa Esperanza (Boston, MA)
- …care. About the role Part-Time: 20 hours per week The role of the Tu Bienestar Case Manager is to ensure clients are linked to care, engaged in care, and ... develop service plans, and complete other related paperwork. The Case Manager will conduct file reviews and...as appropriate Conduct periodic reassessments of the ISP, including review of the utilization of services and… more
- Zenex Partners (San Pedro, CA)
- …2 years of Acute Care experience (can consider 1.5 years) Experience with Utilization Review and Discharge Planning Experience with InterQual 1st-time travelers ... All RTO must be submitted upfront Requirements:… more
- University of Utah Health (Salt Lake City, UT)
- …patients and families. Together with the multiple other internal team member the case manager is responsible for establishing, monitoring and executing patients ... Negotiates with third party payers relative to benefit levels, eligibility, utilization review , and reimbursement. Identifies actual and potential delays… more
- SolutionHealth (Manchester, NH)
- …Job Description: This is a Per Diem opportunity-FOR WEEKEND COVERAGE PRIMARILY! Social Worker Case Manager Who We Are: The Care Coordination Department at the ... Develops discharge plan in collaboration with the interdisciplinary team Coordinate's referrals Utilization review Who You Are: Must demonstrate proficiency in… more
