- BronxCare Health System (Bronx, NY)
- …and implementation of educational programs for Denial Prevention and Management . Responsibilities - Establish and maintain positive relationships with patients, ... participates in the Performance/Quality Improvement activities of the assigned department . Contribution and participation includes data collection, analysis, implementation… more
- AmeriHealth Caritas (Dublin, OH)
- ** Utilization Management Plan Oversight Manager ** Location: Dublin, OH Primary Job Function: Medical Management ID**: 37872 Your career starts now. We ... Chief Medical Officer for the Ohio Market, this position is representing Utilization Management (UM) in state interactions/audits, validation of regulatory… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient charts for timeliness ... of services as well as appropriate utilization of services; and ensuring optimum use of resources,...delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure… more
- Humana (Jefferson City, MO)
- …a part of our caring community and help us put health first** The Manager , Utilization Management Nursing utilizes clinical nursing skills to support ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Nursing works within specific… more
- Cedars-Sinai (Los Angeles, CA)
- …employment. **Req ID** : 4300 **Working Title** : Utilization Management Case Manager - 8 Hour Days Per Diem ** Department ** : Utilization ... Hospitals! **What You Will Do in This Role:** The Utilization Review Case Manager validates the patient's...**Experience:** + Minimum of 2 years experience in Case Management preferred + Minimum of 3 years' Acute Care… more
- Trinity Health (Silver Spring, MD)
- …acute healthcare setting required. + Extensive knowledge of payer mechanisms and clinical utilization management is required **Preferred:** + At least 5-7 years ... - 4:30pm + Reporting to the Director of Care Management + The RN Manager is responsible...development and quality assessment and improvement activities of the department , particularly the Care Managers. Manages the activities of… more
- AdventHealth (Altamonte Springs, FL)
- … will oversee ED, Inpatient, and Specialist utilization , and manage care management outcomes. The Senior Manager of Utilization will provide support, ... and guidance to the RN on care management duties/assignments. The Senior Manager of Utilization will be responsible for auditing the Transition of Care… more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- CVS Health (Springfield, IL)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management /Case Management staff. This position is responsible ... performing teams. Works closely with functional area leadership team ( department Associate Managers, Manager , and other key...years of Managed Care experience + 1+ years of Utilization Management experience + 1+ year Leadership… more
- Sharp HealthCare (San Diego, CA)
- …System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager (UM) partners with the Centralized Patient Placement Center ... Guidelines (MCG). + Experience and understanding of federal and state regulations governing utilization management . + Accredited Case Manager (ACM) -… more
- Catholic Health Initiatives (Lexington, KY)
- …staff in support of the CommonSpirit Health Care Coordination model. The Utilization Management department processes authorizations, inpatient admission and ... both inside our hospitals and out in the community. **Responsibilities** The Utilization Management (UM) Director is responsible for the market(s) development,… more
- LA Care Health Plan (Los Angeles, CA)
- Supervisor, Utilization Management RN Job Category: Clinical Department : Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: ... to achieve that purpose. Job Summary The Supervisor of Utilization Management (UM) RN is responsible for...responsible for executing the day-to-day operations of the UM department , and monitoring the Care Management (CM)… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more **Description** We're seeking an **Assistant Manager , Utilization Review** , responsible for supervising and coordinating ... activities of personnel in the Utilization Review Department , including: + Staff schedules...least 3 years of healthcare experience required. + Case Management certification (CCM or ACM) preferred. + Leadership experience… more
- Healthfirst (NY)
- …of Centers for Medicare & Medicaid Services (CMS) or New York State Department of Health (NYSDOH) regulations governing medical management in managed care ... **Duties/Responsibilities:** + Provides case management services for assigned member caseloads which includes:...with non-partner providers, where applicable. Ensures appropriate access and utilization of a full continuum of network and community… more
- Sutter Health (Burlingame, CA)
- **Organization:** Bay Administration **Position Overview:** Responsible for Utilization Management and accurate bed placement for patients coming in from the ED. ... experience. This position works in collaboration with the Physician, Utilization Manager , Medical Social Worker and bedside...providers and community resources. If assigned to the Emergency Department , the Care Management process is to… 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 ... of National Committee for Quality Assurance (NCQA) requirements for Utilization Management or CM. Knowledge of Department of Health Care Services (DHCS)… more
- Hackensack Meridian Health (Holmdel, NJ)
- …to transform healthcare and serve as a leader of positive change. The **Care Management , Care Coordinator, Utilization Management ** is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… 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 ... implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service,...for Utilization Management or Care Management (CM). Knowledge of Department of Health… more
- Hackensack Meridian Health (Hackensack, NJ)
- …mission to transform healthcare and serve as a leader of positive change. The Case Management Care Coordinator, Utilization Management is a member of the ... patient's treatment. Accountable for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of… more
- McLaren Health Care (Detroit, MI)
- **Position Summary:** Responsible for providing assistance to the Utilization Manager (UM) RN in the coordination of patient admission and continued stay ... observation) based on medical necessity. 2. Performs concurrent and retrospective utilization management -related activities and functions to ensure that… more