- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Sharp HealthCare (San Diego, CA)
- …time for routine, urgent and expedited referrals as outlined in SCMG's Utilization Management Plan.Decisions will be communicated to the appropriate persons ... + Knowledge of medical terminology, healthcare finances, alternative care options, utilization management , health plan criteria, established criteria such as… more
- Universal Health Services (Memphis, TN)
- …and advocates for patient length of stay and level of care. Oversees utilization review activities with other departments to ensure reimbursement for services ... Responsibilities Lakeside Behavioral Health System provides an excellent opportunity for those seeking...treatment team member or 5-7 years of experience in utilization management for both mental health and… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …safe discharge coverage for all hospital units. + Participates in utilization management initiatives/opportunities for improvement through departmental committee ... Florida. + 3 years minimum experience in discharge planning, utilization management , or case management ....with electronic medical records, and/or discharge planning and case management systems . + Able to maintain confidentiality… more
- Sharp HealthCare (San Diego, CA)
- …is appropriate for the referral request being reviewed.Document in the referral management system , according to SCMG operational processes, actions taken on ... the appropriateness of service/care.Attach corresponding documents to the referral within the referral management system in OnBase, the document management … more
- Dignity Health (Northridge, CA)
- …400 care centers. Visit dignityhealth.org/northridgehospital for more information. The RN Utilization Management Coordinator (UMC) is responsible for assessing ... and in compliance of the Behavioral Health Dignity Health Utilization Review Policy. + The UMC will...+ Current CA Registered Nurse (RN) license + Prior Utilization Management experience in a clinical or… more
- Magellan Health Services (Evanston, WY)
- Assists in processing difficult behavioral case management utilization requests in a timely manner according to company guidelines using current knowledge of the ... resource to local agencies for current behavioral health care management systems . + Attends meetings related to...to ensure accurate documentation and reporting. + May process utilization review requests received by phone, fax… more
- Magellan Health Services (Albuquerque, NM)
- …including related correspondence. + Participates in Care Coordination team and utilization management activities, including collaboration with other staff on ... management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers.… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... VP, Medical Affairs in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a… more
- Evolent Health (Columbus, OH)
- …Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + On a ... you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Trinity Health (Livonia, MI)
- …standards and deadlines. Data components will be obtained through the effective utilization of the hospital medical record system . + Demonstrates applicability ... the Information Systems Departments whose support is necessary for the management and success of the program. + Contacts patients and/or families via telephone… more
- Centers Plan for Healthy Living (Margate, FL)
- …preferably in a managed care environment in related area of responsibility, (ie utilization management , quality management , grievances, and appeals) Type of ... RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063,...requirements including timelines. + Presents recommendations based on clinical review , criteria, and organizational policies + Communicates clearly and… more
- Hartford HealthCare (Newington, CT)
- …we now have our own identity with a unique payroll, benefits, performance management system , service recognition programs and other common practices across the ... system . *_Position Summary:_* Responsible for the overall ...and electronic health record (EHR). Facilitate and sustain optimal system -wide performance and resource utilization through on-going… more
- TD Bank (Mount Laurel, NJ)
- …of Business:** Data & Analytics **Job Description:** The Senior Manager Business Information Management manages / leads a team of business information management ... varying in size and complexity that is responsible for supporting business information management needs for a specific area/function. Role may also be a technical… more
- Fresenius Medical Center (San Antonio, TX)
- …operations. + Coordinates the evaluation and enhancement of pharmacy enrollment and utilization tracking tools. + Communicates regularly with other teams such as ... to company, department, program policies and clinical guidelines to identify, review , assess and allocate patients for program participation according to their… more
- Genesis Healthcare (Hanover, NH)
- …of recent clinical experience is required. Must have a valid driver's license. Utilization review , case management , and discharge planning experience is ... in NH in the DHCM, New London, Huggins, Memorial and NH state Hospital Systems . Join the Genesis team as a Clinical Liaison - RN where your marketing/sales… more
- BayCare Health System (Cotton Plant, AR)
- …and clinical excellence. **BayCare Health System ** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and compassionate ... Review or + Required 2 years in Case Management + Preferred 3 years Registered Nurse in Critical...in Critical Care or Emergency Service **Facility:** BayCare Health System , Utilization and Denials Mgmt -MPH… more
- Sharp HealthCare (San Diego, CA)
- …is bedded, during the episode of care and supports other members of the System Centralized Utilization Management team to ensure final status reconciliation. ... while ensuring compliance with all local, state and federal regulations governing utilization review activities and/or care management . Expected outcomes… more
- The Mount Sinai Health System (New York, NY)
- The Utilization Review Manager for the Selikoff Centers...System is one of the largest academic medical systems in the New York metro area, with more than ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Children's Mercy Kansas City (Kansas City, MO)
- … as well as training/oversight of programs and services. Responsible for effective utilization review and proper resource management , including patient ... accountability and escalation pathways for resolving utilization management issues throughout the health system . +...hardware and software. + Acts as a liaison/expert regarding utilization review , care management , and… more