- 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
- Catholic Health (Kenmore, NY)
- …of experience working in an Acute Care Hospital Setting + Proficiency in utilization management and regulatory requirements preferred + Experience in working ... RN with a BS in health-related field and working knowledge /experience in documentation utilization review in an...Manager (CCM) + Certification in a Nationally Recognized Utilization Review Criteria set is preferred + At least… more
- Prime Healthcare (Montclair, CA)
- …Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/221097/discharge-planner utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityMontclair… more
- CenterWell (Austin, TX)
- …+ Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability ... Orthopedic procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare… more
- University of Utah Health (Salt Lake City, UT)
- …skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to demonstrate ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more
- Community Health Systems (Franklin, TN)
- …or similar environment preferred ** Knowledge , Skills and Abilities** + Strong knowledge of utilization management principles, payer requirements, and ... Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals… more
- South Middlesex Opportunity Council (Framingham, MA)
- …casual Working Conditions: As part of the responsibilities of this position, the Utilization Management Coordinator will have direct or incidental contact with ... children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... health care, part of which may be experience in Behavioral health managed care. Knowledge , Skills and Abilities: Working knowledge of Microsoft Word, Excel and… more
- US Tech Solutions (Columbia, SC)
- … management program interventions. Utilizes clinical proficiency and claims knowledge /analysis to assess, plan, implement, health coach, coordinate, monitor, and ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates… more
- Providence (Irvine, CA)
- …health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management , medical necessity, ... and patient status determination. The Utilization Management RN must effectively and efficiently manage a diverse workload in a fast-paced, rapidly changing… more