- Pacific Medical Centers (Renton, WA)
- …and USFHP Medical Director (s) to develop and implement strategic case management and utilization management yearly goals. Providence caregivers are ... RN is responsible for the supervision of case management (CM) and utilization management ...and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... care. Uses defined resources to guide decisions, including Medical Director Care Management , Physician Advisors, and ...relevant experience Three to five years' experience in care management , utilization review , home care… more
- Gilead Sciences, Inc. (Foster City, CA)
- …the lives of patients for generations to come. Reporting to the Executive Director of Global Medical Affairs Technology, this individual will be responsible for ... our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include...on the project status and budget to the Executive Director of Medical Affairs Technology + Be the primary… more
- Carnival Cruise Line (Miami, FL)
- …to risk management , legal, HR, and clinical governance teams. + Review crew claims for relevance and appropriateness in coordination with internal and external ... This role reports to the Senior Manager of Case Management and oversees the daily operations of crew case management . The Manager leads a team of specialists to… more
- Sharp HealthCare (San Diego, CA)
- …nursing experience or case management experience. + 3 Years case management , utilization review , care coordination experience. + California Registered ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving… more
- University of Southern California (Los Angeles, CA)
- …to multi-task. Preferred Qualifications: + Pref Bachelor's degree + Pref 1 year Case management or utilization review experience within the last three years ... The RN case manager role integrates the functions of utilization management , quality management , discharge...Participates in InterQual competency testing as requested by department director . + Outcomes Management * Participates in… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- Elevance Health (Tampa, FL)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education and ... **Must reside in the state of Florida** The **Medical Management Nurse** will be responsible for review ...treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do not… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …true colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as evaluating ... Medical Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team:… more
- Johns Hopkins University (Baltimore, MD)
- …Operations Manager,_** **_SNF Agora_** who will be responsible for assisting the Director of Capital Planning and Facilities Management with the overall ... in the SNF Agora Building. + Collaborate with the Director of Capital Planning and Facilities Management ...special projects as needed, such as space assessments and utilization , crisis management and safety protocol. **Special… more