- Sharp HealthCare (San Diego, CA)
- …You Will Do** As a member of the System Integrated Care Management (ICM) team the Utilization Manager ( UM ) II position supports utilization review ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- Sharp HealthCare (San Diego, CA)
- …of the System Integrated Care Management (ICM) team the Transfer and Admissions Utilization Manager ( UM ) partners with the Centralized Patient Placement ... Guidelines (MCG) + Experience and understanding of federal and state regulations governing utilization management + Accredited Case Manager (ACM) - American Case… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II ...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will...in the department's continuous quality improvement activities. Communicates to UM Manager and supervising RN, barriers to… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II ...and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II will facilitate, coordinate, and approve… more
- Elevance Health (Cerritos, CA)
- …required by managers. **Shift:** **M-F; 8:30am-5:00pm** Responsible for Behavioral Health Utilization Management (BH UM ), or Behavioral Health Case Management ... of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. +...of care for inpatient/outpatient + BH services; ensures appropriate utilization of BH services through level of care determination,… more
- Hackensack Meridian Health (Hackensack, NJ)
- …and provide assistance and support in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals and clinical improvement ... **Overview** The Senior Utilization Review Physician Specialist collaborates with the healthcare...formal educational lectures and engage in frequent informal meetings ii . Retrospective Medical Record Documentation Review iii. Clarifying ambiguous… more
- Elevance Health (Rocky Hill, CT)
- …insightful analytics to improve the delivery of care.** **BH Care Manager II ** Responsible for authorizing and reviewing utilization of mental health and ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...is licensed staff supervision. + Previous experience in case management/ utilization management with a broad range of experience with… more
- Elevance Health (Jacksonville, FL)
- …depression, and insightful analytics to improve the delivery of care.** **BH Care Manager II ** Responsible for managing psychiatric and substance abuse or ... healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to...is licensed staff supervision. + Previous experience in case management/ utilization management with a broad range of experience with… more
- Elevance Health (Seven Fields, PA)
- …Monday-Friday 8:00 am -5:00 pm Eastern Standard Time The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse or ... necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more
- Elevance Health (Las Vegas, NV)
- …and insightful analytics to improve the delivery of care. **Behavioral Health Care Manager II ** Location: This position is primarily a virtual/remote role. ... pm, Pacific Standard Time Zone.** The **Behavioral Health Care Manager II ** is responsible for managing psychiatric...healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to… more
- Elevance Health (Costa Mesa, CA)
- **Sign-on Bonus:** $3,000 The **Behavioral Care Manager ** ** II ** is responsible for completing clinical assessments, screenings, and managing crisis calls in a ... quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Outreaches to providers as necessary for… more
- Elevance Health (Rocky Hill, CT)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... is also acceptable if all of the following criteria are met: performs UM approvals only, reviews requests for Applied Behavioral Analysis (ABA) services only, and… more
- Elevance Health (Latham, NY)
- …Monday-Friday 8:00 am -5:30 pm Eastern Standard Time The Behavioral Health Care Manager II is responsible for managing psychiatric and substance abuse or ... necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... Equipment (DME) forms and patient status reports.Anticipates and completes documentation needs (ie UM , Plan of Care (POC), patient status reports) prior to their due… more
- Centene Corporation (Mcallen, TX)
- …cost effective care. + Assess the member's current health status, resource utilization , past and present treatment plan and services, prognosis, short and long ... + Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience + Enter and maintain assessments, authorizations, and… more
- LA Care Health Plan (Los Angeles, CA)
- …member care with internal LA Care departments such as Care Management (CM), Utilization Management ( UM ), Managed Long Term Services and Support (MLTSS), Social ... and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required… more
- Elevance Health (Colorado Springs, CO)
- …necessary quality behavioral healthcare in a cost effective setting in accordance with UM Clinical Guidelines and contract. + Refers cases to Peer Reviewers as ... of the United States required. + **Previous experience in case management/ utilization management with a broad range of experience with complex psychiatric/substance… more
- LA Care Health Plan (Los Angeles, CA)
- …health care auditing and monitoring (preferably in Appeals, Grievances, Quality Improvement, Utilization Management ( UM ) and so forth) and developing audit ... Compliance Advisor II Job Category: Administrative, HR, Business Professionals Department:...Compliance unit, the Advisor also advises and supports the Manager , Director, and Chief Compliance Officer on other duties… more
- Sharp HealthCare (Santee, CA)
- …within two months of discharge.Follows policies and procedures for all Utilization Management ( UM ), discharges, Standardized Outcome Measures, Durable Medical ... to the PT Supervisor or supporting clinical specialist (PT II or PT III) for resolution in a timely...and patient status reports.Anticipates and completes documentation needs (ie UM , POCs, patient status reports) prior to their due… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …and adherence to accreditation and regulatory standards. 20. Directly reports to the Nurse Manager of CNSO & UM and/or designee. 21. Performs other duties as ... 1. Works closely with the Admission Clerk/Administrative Officer of the Day (AOD)/ Utilization Management group to assure that admission criteria are met, and… more