- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- … review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical, ... financial, and utilization goals through effective management , communication, and...of any of the following: CPHM (Certified Professional in Healthcare Management ), CCM (Certified Case Manager), ACM… 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
- Community Health Systems (Franklin, TN)
- …appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. This role conducts admission and continued ... admissions and extended stays, identifying opportunities for process improvements to enhance utilization management . + Serves as a key contact for facility… 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
- 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
- UTMB Health (Webster, TX)
- …efficient use of medically appropriate services. Integrates and coordinates utilization management activities, care coordination, discharge planning functions, ... UTMB TDCJ Hospital to specialty services hospitals. **_ESSENTIAL JOB FUNCTIONS_** **:** Utilization Management + Demonstrates thorough knowledge of Inter Qual… more
- Behavioral Center of Michigan (Warren, MI)
- …all state mandated regulations. Maintains compliancy with regulation changes affecting utilization management . Reviews patient recrods and evaluates patient ... programs and advises physicians and other departments of regulations affecting utilization management . Consults with Social Services Department regarding the… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- HCA Healthcare (Kissimmee, FL)
- …charitable organizations. Apply Today! **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and ... We care like family! Jump-start your career as a Director Case Management today with HCA Florida...to ensure continuity of care and optimal clinical resource utilization . The Director has oversight for all… more
- HCA Healthcare (Asheville, NC)
- …a part of our team. **Job Summary and Qualifications** The Facility Case Management Director has the overall responsibility for managing and coordinating ... join an organization that invests in you as a Director Case Management ? At Mission Hospital, you...Management ? At Mission Hospital, you come first. HCA Healthcare has committed up to $300 million in programs… more