- 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
- MetroHealth (Cleveland, OH)
- …specifically focusing on payer verification, preadmission processing, authorization, clincial utilization management functions, etc.). Works with the manager ... agreements. Serves as a clinical resource to the physician group and Utilization Management Specialists. Upholds the mission, vision, values, and customer… more
- Hackensack Meridian Health (Old Bridge, NJ)
- …Nursing or Master's Degree in Social Work. The Supervisor , Care Management role integrates and coordinates utilization management , care ... managers **Responsibilities** A day in the life of a Supervisor in Case Management may include: +... setting. Familiar with hospital resources, community resources, and/or resource/ utilization management . Care coordination, case… 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
- Centene Corporation (Raleigh, NC)
- …team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... 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
- Dignity Health (Rancho Cordova, CA)
- …Summary:** Under the guidance and supervision of the department Manager/Director, the Supervisor of Utilization Management is responsible and accountable ... (Medicare Guidelines, InterQual, Health Plan Benefit Interpretation Guidelines and Medical Management Policies, and DHMF Utilization Management guidelines… 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
- Banner Health (AZ)
- …employment options by offering remote and hybrid work settings. As a Behavioral Health Utilization Care Manager, you will be assigned to various hospitals where ... a proficiency level typically achieved with three years clinical experience (ie counseling, care management , case management , care coordination in… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …requests for specific services. Under the supervision of the Health Service Supervisor , the Utilization Management Representative is primarily responsible ... **Responsibilities** The Utilization Management Representative (UMR) provides office...level courses **Experience** Required: 2 -3 years of managed care experience either in a physician office or hospital… 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
- Intermountain Health (Las Vegas, NV)
- …health plan criteria, MCG criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case management , ... work experience related to inpatient management , case management , utilization management , quality ...Certified in Internal Medicine, Family Practice, or other primary care specialty. + Current Nevada DEA certificate required prior… more
- Providence (Everett, WA)
- **Description** ** Utilization Management Assistant (279237)** **Schedule: FTE 1.0, Monday-Friday 08:00AM - 4:30PM PST (8HR SHIFT), Day** The primary ... responsibility of the position is to maintain standard compliance and performance related utilization management data. Process of daily, weekly and monthly UM… 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)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN 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
- Sharp HealthCare (San Diego, CA)
- …Skills, and Abilities** + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, ... time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons… 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
- Sharp HealthCare (San Diego, CA)
- …Skills, and Abilities** + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, ... with supervisor , team lead and/or medical director to discuss requests/ care inconsistent to criteria and determine the appropriateness of service/ care .Attach… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …management standards. Assists supervisor and other units of Care Management maintaining department timeliness standards and participating on ... of related experience is required **Work Experience** + 3 years of direct patient care /clinical experience which includes two years of managed care is required… more