- Magellan Health Services (Boise, ID)
- …community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. + Participates in ... solutions that directly influence quality of care. General Job Information Title Care Manager ( UM /UR) - Remote, Idaho Licensed Grade 24 Work Experience -… more
- Magellan Health Services (Boise, ID)
- …of healthcare services in physical health, behavioral health or other medical specialty area based on pod management. Considerable skill in interpreting clinical ... for RN, Masters or Doctoral level provider. General Job Information Title Clinical Manager , Behavioral Health ( UM ) -Licensed, Remote in Idaho Grade 27 Work… more
- UPMC (Pittsburgh, PA)
- …Preference will be given to candidates located in Pennsylvania. The Utilization Management ( UM ) Care Manager is responsible for utilization review of health plan ... you! We are hiring a full-time Utilization Management Care Manager to support the Utilization Management Clinical Operations Department....with health plan medical director to discuss medical necessity for requested service . + Document… more
- Queen's Health System (Honolulu, HI)
- …the business plan and alignment with the strategic plan and vision of the Medical Center. * Ensures functions, activities, services , and programs meet all ... and clinical operations of Emergency Department and Inpatient Case Management services . * Develops, implements, monitors and evaluates for effectiveness, a… more
- Healthfirst (NV)
- …PCP and other medical providers to coordinate treatments, collateral services , and service authorizations. Negotiates rates with non-partner providers, where ... The Case Manager , Utilization Management coordinates the care plan for...concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations… more
- Healthfirst (MD)
- …PCP and other medical providers to coordinate treatments, collateral services , and service authorizations. Negotiates rates with non-partner providers, where ... preadmission, concurrent, and retrospective reviews to evaluate the appropriateness and medical necessity of treatments and service utilizations based on… more
- Ventura County (Ventura, CA)
- Manager - Patient Services - Ventura County Health...per year, increasing to 288 hours after 5 years of service , to 328 hours after 10 years of service ... Care Plan Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5064489) Apply Manager - Patient Services - Ventura County..., and to 368 hours after 15 years of service or other public service . *Credit for… more
- Providence (Santa Rosa, CA)
- …Accredited Case Manager (ACM) upon hire + For Case Management/ UM Review: Strong operations experience. **Why Join Providence?** Our best-in-class benefits are ... of the RN Case Managers in the Care Management Department. The Manager role models proactive, collaborative working relationships across all functions. Specifically… more
- Cedars-Sinai (Beverly Hills, CA)
- …eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/ Manager /Director/ Medical Director to research any issues ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM ...patient population, including referrals to community resources, facilitation of medical services , referral to ancillary providers, etc.… more
- Cedars-Sinai (Beverly Hills, CA)
- …eligibility before processing authorizations. + Contacts facilities identified by the UM Nurses/ Manager /Director/ Medical Director to research any issues ... when requested. + Requests support documentation from IPAs / Medical Groups as requested by the UM ...: MNS Ambulatory Care Mgmt **Business Entity** : Cedars-Sinai Medical Center **Job Category** : Patient Services … more