- Queen's Health System (Honolulu, HI)
- …experience in a comparable role highly preferred. * Experience to demonstrate: o Knowledge of case management , utilization review processes and discharge ... management . o Knowledge of community care management practices preferred. o Knowledge of and experience with Milliman Care Guidelines (MCG) preferred.… more
- Dartmouth Health (New London, NH)
- …situations * Good organizational and problem-solving skills * Clinical Pathways, utilization management , and discharge planning knowledge preferred. ... collaboration with the clinical team, providing leadership for the management of patient care and resulting outcomes. * FUNCTIONAL...duties as required or assigned. * POSITION REQUIREMENTS * Knowledge / Skills / Abilities * * Must have… more
- Arnot Health (Elmira, NY)
- …insurance companies with requested patient information as needed. 10. Maintains a working knowledge of programs necessary for denial management (ie: excel, word, ... Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review and appeal as appropriate...assist with appeal of denials 2. Maintains a working knowledge of the requirements of 3rd party payers 3.… more
- Stanford Health Care (Palo Alto, CA)
- …Risk Management . **Licenses and Certifications** + CPM - Certified Purchasing Manager (Certification By The Institute For Supply Management ) preferred or + ... LPCH, PCHA, UHA, SBC and new activations as appropriate). The Category Manager is responsible for driving category specific contract coverage and compliance. Areas… more
- Ellis Medicine (Schenectady, NY)
- …provided by the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration with physicians and social ... SECTION I BASIC FUNCTION: The RN Case Manager has responsibility for case management ...discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR… more
- CenterWell (Tampa, FL)
- **Become a part of our caring community and help us put health first** The Manager Care/Case Management in **Tampa area (** **_this is not a remote position_** ... for managing populations and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel requirements to preferred… more
- Houston Methodist (Houston, TX)
- …projects to bigger picture system ideas.** At Houston Methodist, the Senior Manager Operations position is responsible for the strategic and ongoing development, ... effective interpersonal skills and oral/written communication skills. The Senior Manager Operations position is responsible for the efficient and effective… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... to enhance their knowledge and skills related to health or lifestyle management . + Contact members with gaps in preventive health care services and assist them… more
- Tenet Healthcare (Detroit, MI)
- …Technical knowledge of community resources, regulatory requirements, reimbursements, and utilization management procedures in order to function Job : Nursing ... national standards for case management scope of services including: * Utilization Management supporting medical necessity and denial prevention * Transition … more
- Magellan Health Services (Newtown, PA)
- …health care setting. Strong organization, time management and communication skills. Knowledge of utilization management procedures, mental health and ... other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided...an active work load in accordance with National Care Manager performance standards. + Works with community agencies as… more
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