- Reno Behavioral Healthcare Hospital (Reno, NV)
- …an interdisciplinary approach to support continuity of care. + Provides utilization management , transfer coordnation, discharge planning, and issuance of ... The UR Specialist reviews and monitors patients' utilization of health care services with the goal...and quality of care. + Responsible for the proactive management of patients with the objective of improving quality… more
- ERP International (Barksdale AFB, LA)
- …co-workers, families, peers, and other health team members. Submits all concerns through Utilization Management Director ; be able to identify, analyze and ... **Overview** ERP International is seeking a ** Utilization Management Registered Nurse (RN)** for...and criteria to review thequality, completeness, and adequacy of healthcare provided within the MTF, as well asits necessity,… more
- LA Care Health Plan (Los Angeles, CA)
- …observation) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director , on requests where determination ... Utilization Management Admissions Liaison RN II...data presented and established criteria/guidelines, escalating to the medical director if needed. Triages and assesses members for admission… more
- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical...in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon… more
- Tenet Healthcare (Detroit, MI)
- … model, staffing and skill mix, complex Case Management , and centralized utilization review · Participate in new hospital Director of Case Management ... Group Director of Case Management - 2506001359...individual in this position has overall responsibility for hospital utilization management , transition management and… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- CVS Health (Topeka, KS)
- …services and/or programs + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends ... and external constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with… more
- Sharp HealthCare (San Diego, CA)
- …to accrediting and regulatory agency feedback. + Supports pre-admission review, utilization management , and concurrent and retrospective review Process. Performs ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review, outreach programs, HEDIS reporting, site… more
- HCA Healthcare (Nashville, TN)
- …to join an organization that invests in you as a Sr Director Labor Management Technology? At HCA Healthcare , you come first. HCA Healthcare has committed ... members over the course of three years. **Benefits** HCA Healthcare , offers a total rewards package that supports the...a difference. We are looking for a dedicated Sr Director Labor Management Technology like you to… more
- AdventHealth (Glendale Heights, IL)
- …AVE, Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient… more