- Northwell Health (New Hyde Park, NY)
- …experience post-licensure, with a significant portion (4+ years) directly in a managed care organization, Pharmacy benefit manager , or health plans + Experience ... the development, implementation, and maintenance of drug formularies, clinical utilization management (UM) criteria, and evidence-based drug therapy guidelines, and… more
- Houston Methodist (The Woodlands, TX)
- …approved utilization criteria to monitor appropriateness of admissions, level of care , resource utilization , and continued stay. Reviews level of care ... for hospital services by communicating medical information required by all external review entities, managed care contracts, insurers, fiscal intermediaries, and… more
- UNC Health Care (Rocky Mount, NC)
- …and wellbeing. Summary: Provides general clerical, secretarial and organizational support to the Manager of Care Management, to the departmental staff, and to ... Managers (CM), Social Workers (SW), and Point of Entry Utilization Managers (POE UM) *Discuss referred cases, including, patient... Management Process. 4. Complete FL2 for Long Term Care and Pre-Admission Screening and Resident Review … more
- BronxCare Health System (Bronx, NY)
- …and department staff when prevented from completing job tasks. -Assists the Administrative Manager and Director with annual review and revisions of departmental ... Overview The Appeals Manager is responsible to assist in the analysis...denial being overturned providing the hospital reimbursement for the care and services provided to the patient. The Denial… more
- Erickson Living (Springfield, VA)
- …leadership meetings such as Wound Rounds, Clinical Operations Meeting, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee ... Erickson Senior Living Join our team as the Nurse Manager , RN also known as the Clinical Manager...evaluation of the delivery of safe and effective person-centered care of our 32-bed Rehab neighborhood . The Clinical… more
- UPMC (Pittsburgh, PA)
- …oversight of the day-to-day operations of the authorization, denial management, and/or utilization review functions of UPMC Revenue Cycle, involving both ... Purpose: UPMC Corporate Revenue Cycle is hiring a Clinical Manager to join our Care Management Team!...as a resource person for authorization, denial management and/or utilization review processes. + Assess and respond… more
- University of Southern California (Alhambra, CA)
- …work list to manage daily assigned caseload, as assigned by the Lead Ambulatory Care Manager . 3. Assess physical and biopsychosocial needs of the patient through ... In collaboration with the interdisciplinary team, the Case Manager provides care coordination services evaluating...experience + Req 2 years Ambulatory case management or utilization review experience within the last three… more
- Ochsner Health (New Orleans, LA)
- …facilitations of care throughout a patient's hospitalization, which includes a review of the appropriate utilization of resources, balanced with the ... 3 years of hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license… more
- HCA Healthcare (El Paso, TX)
- …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other… more
- HCA Healthcare (Gainesville, FL)
- …and/or cellular therapy is required. + Certification in case management, nursing, or utilization review desired. + Bachelors degree required. HCA Florida North ... nurses to work more efficiently. **Are you passionate about delivering patient-centered care ?** Submit your application for RN Case Manager Hematology position… more