- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role The Manager , Utilization Management (UM) will manage the Utilization Management team consisting of Clinicians and Non-Clinical support ... Primary Responsibilities + Coordinate day to day operations of the Utilization Management team. + Serve as the primary contact for day-to-day operational… more
- Elevance Health (Washington, DC)
- …office 4 days each week. The office is located at 609 H. Street NE.** The ** Manager of Utilization Management ** **ll** is responsible for managing a team of ... and acuity. + Provides direct oversight and is responsible for Utilization Management execution/decision making for managed member populations. Primary… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... of Experts and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager , you will:** + Directs staff performance regarding… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... 5:30 pm Holiday and weekend coverage when needed. The Manager of Care Management I leads and... Management I leads and collaborates with care management operations across utilization review, acute and… 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...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Prime Healthcare (Weslaco, TX)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/233537/registered-nurse-case- manager utilization - ... CENTER IS LOOKING FOR A PRN REGISTERED NURSE CASE MANAGER TO WORK WEEKENDS. WE OFFER: + Competitive PRN...visit www.KnappMed.org Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
- Prime Healthcare (Montclair, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/229421/case- manager -%28rn%29 utilization - ... community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...admission and across the continuum of the health care management . Works on behalf of the advocate, promoting cost… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed… more
- Amergis (Sacramento, CA)
- Registered Nurse Case Manager - Utilization Management + Location: Sacramento, CA + Start Date: ASAP + Assignment Length: 13 Weeks + Openings: 1 + Weekly ... Friday Requirements: + Minimum 1 year of acute/inpatient case management experience + Prior utilization review experience...License + Basic Life Support (BLS) The RN Case Manager is responsible for coordinating continuum of care activities… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …a web-based application for daily entry of case activity and the utilization management of service authorizations. Educational and Experience Requirements: MA/MS ... Salary: $65,000/year Position Summary: The UM Program Manager provides oversight and management of...summ ar ize d ata wit h in the Utilization M an agementSys tem to pr eparere por… more
- Community Health Systems (Bentonville, AR)
- …live! **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under ... services, escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. + Identifies avoidable hospital days and communicates… more
- Community Health Systems (Bentonville, AR)
- **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the ... services, escalating cases as needed to the Physician Advisor or Utilization Management (UM) committee. + Identifies avoidable hospital days and communicates… more
- Beth Israel Lahey Health (Plymouth, MA)
- …its **Care Transitions Department** and seeking an experienced ** Manager of Utilization Review & Denials Management ** and ** Utilization Review** ... CCM, ACM, or other case management certification preferred or in progress ** Manager - Utilization Review & Denials Management ** This role is ideal for a … more
- AmeriHealth Caritas (Philadelphia, PA)
- …us at www.amerihealthcaritas.com . **Responsibilities:** Under the supervision of the LTSS Manager /Director for Utilization Management , this position is ... Home Modification Team and staff members within the LTSS Review Utilization Management Department. Responsibilities include providing technical and operational… more
- Amergis (Orange, CA)
- …Case Manager to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management ) will be responsible for reviewing and ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral… more
- Veterans Affairs, Veterans Health Administration (Seattle, WA)
- …Washington. The Nurse Manager directly supervises the RN Utilization Management /Discharge Planners, AMSA Discharge Coordinators, Patient Access Center ... managing complex client care. The position directly supervises the RN Utilization Management /Discharge Planners, AMSA Discharge Coordinators, Patient Access… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders, bed… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional...financial, and utilization goals through effective management , communication, and… more
- Trinity Health (Berwyn, IL)
- …are currently looking for an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general ... supervision, manages Utilization resources and quality of healthcare services through performing initial intake, support and processing of pre-certification requests for eligible members received via portal, EHR, or telephonic, for outpatient and inpatient… more