- Mayo Clinic (Phoenix, AZ)
- …in the inpatient and ambulatory settings. The RN Manager effectively resolves utilization review and denial management issues, provides leadership in ... of hospital-based case management , including discharge planning and utilization review experience. **Additional Qualifications:** + Knowledge of… more
- Cedars-Sinai (Los Angeles, CA)
- …**Req ID** : 1072 **Working Title** : CSMC 8750000 Utilization Management Utilization Review Case Manager FR 48010 Allen 429 1.00 **Department** : ... **Job Description** **Job Summary: Key Job Responsibilities** The Utilization Review Case Manager ...Utilization Management **Business Entity** : Cedars-Sinai Medical Center **Job Category**… more
- Children's Mercy Kansas City (Kansas City, MO)
- …improve the lives of children beyond the walls of our hospital. Overview The Manager of Utilization Review will provide leadership to integrated inpatient ... as well as training/oversight of programs and services. Responsible for effective utilization review and proper resource management , including patient… more
- Beth Israel Lahey Health (Burlington, MA)
- …**Scheduled Hours:** 40 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Full Time ... Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...to ensure a timely process. Registered Nurses (RNs) with utilization review experience, case management … more
- Emanate Health (Covina, CA)
- …United States, and the #19 ranked company in the country. **Job Summary** The Manager Utilization Review /MediCal Specialist will develop and maintain a full ... care from pre-admission through post-discharge for Medi-Cal patients. The Manager Utilization Review /MediCal Specialist will...clinical experience. Minimum of two recent years of Case Management , Utilization Review or Medi-Cal… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Full time **Shift:** **Description:** **Are you an experience RN Manager , Utilization Review of Acute Care seeking your next ... adventure?** **Duration:** 13-week Assignment The Interim Utilization Management , RN Manager ... Management will ensure the timely delivery of utilization review , discharge planning and support case… 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 ... while ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management . Expected outcomes… more
- Catholic Health (Lockport, NY)
- …and Holiday Rotation Hours: 8:00a-4:00p, 9:00a-5:00p, 10:00a-6:00p, 11:00a-7:00p Summary: The RN Care Manager , Utilization Review / Transitions of Care, as an ... Management and interdisciplinary care team, provides comprehensive Utilization Review and transitions of care services...review experience in the role of a Care Manager or Disease Manager , Population Health ,… more
- The Mount Sinai Health System (New York, NY)
- The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations within a ... medical records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to… more
- UNC Health Care (Chapel Hill, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... & the Hospitals? Utilization Management Plan. In addition, the Utilization Manager is responsible for revenue protection by reconciling physician orders,… more
- Immigration and Customs Enforcement (IN)
- …Appropriately refers cases for high level of review and participates in Utilization Management Review Committee activities as needed. Incumbent reviews ... Assistant Director for Healthcare Compliance, Office of Health Plan Management . The Senior Utilization Review ...report directly to the IHSC Regional Utilization Manager with the Utilization Management … more
- Hackensack Meridian Health (Hackensack, NJ)
- …and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate...ie MCG ) b. Supports & Participates in pre-admission review , utilization management , and concurrent… more
- Centene Corporation (Sacramento, CA)
- …care, provider interactions, and facilitates operations within utilization management . + Manages prior authorization, concurrent review , and retrospective ... with applicable guidelines, policies, and procedures + Reviews and analyzes utilization management activities, operations, costs, and forecasted data to… more
- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager...participation in and follow up of Utilization Management audits, such as readiness review , Data ... for UM DE, and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration with all departments to… more
- Humana (Columbus, OH)
- …help us put health first** Humana Healthy Horizons in Virginia is seeking a Manager , Utilization Management (Behavioral Health) who will utilize their ... communication of behavioral health services and/or benefit administration determinations. The Manager , Utilization Management (Behavioral Health) applies a… 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 ... loan reimbursement Under the direction of department leadership, the Utilization Review / Management RN. This...*Priority 5: Escalation *Refers cases that require second level review to Physician Advisor, Manager , and Director… more
- Hackensack Meridian Health (Hackensack, NJ)
- …standards, and regulatory/payor requirements. The role integrates and coordinates utilization management , care coordination, discharge planning functions and ... for disciplinary action and performance improvement plans when appropriate in conjunction with Manager of Case Management . **Responsibilities** A day in the life… more
- Prime Healthcare (Bloomington, IN)
- …current. #LI-AS2 Connect With Us! (https://careers-primehealthcare.icims.com/jobs/161307/case- manager utilization - review ... Rights: https://www.eeoc.gov/sites/default/files/2022-10/EEOC\_KnowYourRights\_screen\_reader\_10\_20.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to the… more
- Prime Healthcare (Lynwood, CA)
- …and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/156578/rn-case- manager utilization - review ... https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities Responsible for the quality and resource management of all patients that are admitted to… more
- Glens Falls Hospital (Glens Falls, NY)
- …be foundhere. **Job:** **Nursing - Case Management * **Title:** *Registered Nurse - Utilization Review Nurse - Care Management (Sign-On Bonus for ... timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and… more