- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager Utilization Management , the Nurse Utilization Management (UM) ... authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy + Works… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization - ... information visit www.westanaheimmedctr.com. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility… more
- Prime Healthcare (San Dimas, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/229285/case- manager -%28rn%29 utilization - ... preferred, and community focused. Responsibilities Responsible for the quality and resource management of all patients that are admitted to the facility from the… more
- Molina Healthcare (WA)
- …unrestricted State RN or Clinical Social Worker/Counseling License. + Certified Case Manager (CCM), Utilization Management Certification (CPHM), Certified ... licensing mandate. + At least 2 years in case, disease or utilization management ; managed care; or medical/behavioral health settings. + One year of training… more
- Molina Healthcare (GA)
- …services professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term ... or more of the following activities: care review, care management , utilization management (prior authorizations,...and unrestricted in state of practice. * Certified Case Manager (CCM), Certified Professional in Health Care Management… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Guthrie (Sayre, PA)
- …approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of ... inpatient admissions and short procedures by translating clinical information to Utilization Management requirements using pre‐determined criteria. b. Documents… more
- Dignity Health (Rancho Cordova, CA)
- …, and efficient pharmacy services across various ambulatory settings. The Manager oversees utilization management , streamlines pharmacy procurement ... including, but not limited to: drug procurement, preparation, prescription renewal, utilization management , patient assistance and associated pharmaceutical care… more
- Ellis Medicine (Schenectady, NY)
- …beneficiaries per CMS Conditions of Participation at the direction of the Case Manager . * Utilization Management Activities; Collaborates with Case Managers ... to make post discharge arrangements for patients. Assists Case Manager or Social Worker by offering choice of providers....and other team members for optimal Utilization Management information throughout the continuum. Maintains… more
- Trinity Health (Chelsea, MI)
- …Part time **Shift:** Rotating Shift **Description:** **Registered Nurse** **Case Manager ** **Department:** Utilization Management **Location:** Chelsea, ... **Position Purpose:** Exceptional opportunity for a Registered Nurse Case Manager to support our vision and serve with us...use of care plans, critical pathways, managed care, and utilization review processes and collaboration with all members of… more