- Alameda Health System (Oakland, CA)
- Director , Inpatient System Care Management + Oakland, CA + Highland General Hospital + SYS Care Coordination + Full Time - Varies + Management + Req ... Alameda Health System is hiring!Under the direction of the Vice President of Care Management , the Director of Inpatient System Care Management … more
- Virginia Mason Franciscan Health (Bremerton, WA)
- …annual bonus eligibility, and more! **Responsibilities** **Job Summary / Purpose** The Utilization Management (UM) Director is responsible for the ... staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and… more
- Trinity Health (Boise, ID)
- …of two years' experience in hospital based medicine with exposure to utilization management and documentation initiatives. 3. Demonstrated teamwork, performance ... is seeking a physician leader to become our Medical Director of Documentation and Utilization Excellence. This...MDDUE will work in a dyad partnership with the Director of Clinical Resource Management . This position… more
- Ascension Health (Austin, TX)
- …and fully insured clients to implement and manage comprehensive outpatient and inpatient utilization management programs. + Oversee implementation and ... Provide strategic direction and oversight of the day-to-day operations of utilization management function within the insurance plan. + Ensure… more
- Helio Health Inc. (Syracuse, NY)
- …Implements quality improvement strategies to include establishment of outcome standards and utilization management . + Responsible for clinical care, bed ... program development and ongoing quality improvement strategies. The Service Director will oversee ourWillows Inpatient Program. In...utilization and fiscal management which includes all tasks… more
- Universal Health Services (Harahan, LA)
- … UTILIZATION REVIEW DIRECTOR to direct and serve within the Utilization Management team. Evaluates patient medical records to determine severity of ... with a psychiatric mental health population desired. 2-3 years experience in Utilization Review. Management experience preferred. + Education: Bachelors prepared… more
- Sharp HealthCare (San Diego, CA)
- …practices. **What You Will Do** This position supports the system centralized utilization management department to meet division and organizational objectives, ... and escalation of concerns to the ICM System Centralized Utilization Management team to mitigate denials. Assists...denial.Prepare databases and written reports for leads, manager, and director in a timely manner as requested and within… more
- YesCare Corp (Bartow, FL)
- …Veterans._ **Responsibilities** Below is a list of your responsibilities as a ** Utilization Management Coordinator** with YesCare: + Confirms admissions with ... outside hospitals and notifies the Utilization Management Department of need to report...outpatient services, codes, and forwards to Corporate UM Medical Director + Performs monthly audit of Inpatient ,… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer, in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for prior authorization/certification for reimbursement of patient care… more
- Beth Israel Lahey Health (Burlington, MA)
- …in utilization review and medical necessity activities Key responsibilities: Utilization review and inpatient clinical optimization: (include all ... Advisor will play an active role in optimizing healthcare resource utilization , ensuring quality, patient care, and managing valuable organizational resources. The… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and… more
- Immigration and Customs Enforcement (IN)
- …and external stakeholders (eg, Customs and Border Patrol, Veterans Affairs) regarding utilization management (UM) processes, trainings, and principles to ensure ... ICE Health Service Corps (IHSC), Office of Deputy Assistant Director for Healthcare Compliance, Health Plan Management ..., administration, or evaluation of public health programs. Healthcare management or utilization management is… more
- Billings Clinic (Billings, MT)
- …leadership and Physician Advisor, per department process or procedure *Insurance and Utilization Management *Maintains working knowledge of CMS requirements and ... starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! RN - Utilization Review (Full-time/Billings) CARE MANAGEMENT (Billings Clinic… more
- Intermountain Health (Las Vegas, NV)
- …medical license. + Minimum of 5 years work experience related to inpatient management , case management , utilization management , quality management ... Reviewer, you are responsible, in partnership with the Sr. Director of UM and the Director of...criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will...of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and… more
- Universal Health Services (Pembroke, MA)
- …LICSW, LMHC with current license in the State of Massachusetts. + Experience in Utilization Management either with a provider, insurance or HMO organization. + ... of obtaining certification and approval for payment in the inpatient and partial levels of hospitalization. The Utilization...Serves as the primary contact for all payors regarding utilization review and management issues. + Performs… more
- State of Indiana (Indianapolis, IN)
- …Nurse (RN) in the State of Indiana. * Two years prior experience with utilization management . * Demonstrated competence in quality assurance and case ... Utilization Review Coordinator Date Posted: May 31, 2024...cost efficient medical outcomes for patients in need of inpatient and/or outpatient precertification/preauthorization. Responsible for evaluating the appropriateness… more
- Martin's Point Health Care (Portland, ME)
- …Nurse required; BSN preferred. + 3+ (total) years clinical nursing experience + Utilization management experience in a managed care or hospital environment ... to Work" since 2015. Position Summary Job Description The Utilization Review Nurse works as a member of a...medical outcomes for those enrollees with a need for inpatient / outpatient authorizations. This position receives and reviews prior… more
- Albany Medical Center (Albany, NY)
- …Management /Social Work Work Shift: Day (United States of America) Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. Salary: $65,062.40 - $107,348.80 * Completes Utilization Management and Quality Screening for assigned...in both areas.* Refers cases and issues to Medical Director and Triad Team in compliance with Department procedures… more
- CVS Health (Phoenix, AZ)
- …talking, listening and computer useRequired Qualifications + 1+ year varied Utilization Management experience within an inpatient /Outpatient setting, ... clinical criteria and clinical practice guidelines for treatment and services both inpatient and outpatient requiring precertification. The majority of the time is… more