- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ensure ... CVS Aetna takes a team-based approach to providing outstanding patient care. Transitional Care Manager is an integral part of the team. The TCM is the primary member… more
- HCA Healthcare (Kissimmee, FL)
- …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... the educational leader to physicians and employees as it relates to utilization review , resource management, patient flow, multi-disciplinary rounds and hospital… more
- Gilead Sciences, Inc. (Foster City, CA)
- …change over time, our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include but are not ... + Hands on experience administering and deploying platforms for Material Review (Veeva MedInquiry, VeevaVault, MedDocs) preferred. + Additional certifications in… more
- UPMC (Pittsburgh, PA)
- …by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care ... Are you an experienced nurse with a background in case management? Are you interested in the opportunity to...for you! We are hiring a full-time Telephonic Care Manager to join the Home and Community-Based Services (HCBS)… more
- Molina Healthcare (Reno, NV)
- …License must be active and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management certification ... performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical… more
- Beth Israel Lahey Health (Wakefield, MA)
- …to the social and emotional impact of illness and disability. The Care Manager upholds the current standards of professional case management practice, and ... services are provided to the BILHPN provider's risk populations. The Care Manager provides care management services to the BILHPN primary care physicians focusing… more
- Catholic Health (Buffalo, NY)
- …acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Manager , Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case... Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary… more
- Providence (Olympia, WA)
- …Surgical or Inpatient setting + IRR or annual competency testing in Utilization Review **Preferred qualifications:** + Bachelor's Degree Nursing or higher ... Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS program or… more
- CenterWell (Atlanta, GA)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and… more
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more