- Mount Sinai Health System (New York, NY)
- …the Daily Management Board process/practice improvement activities to facilitate the utilization of evidence and data related to Nurse Sensitive Indicators ... **Job Description** The Director of Nursing Professional Practice is a professional nurse with broad knowledge and skill in the professional practice standards, NYS… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... Team Ivyhill is currently seeking to hire Referral Management (Non- Nurse ) Reviewers to support its...review duties, seeking guidance from the product line nurse (s), and other members of the healthcare team and… more
- Molina Healthcare (Las Vegas, NV)
- …learn new programs. Preferred Qualifications * Experience with utilization /quality program management . * Managed care experience. * Peer review experience. * ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Select Medical (Lake Worth, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …, and business case consultant for leadership as they relate to case/disease/ utilization management . * Coordinates the development, revision and implementation ... and cost control. Required Skills and Experience * Registered nurse or licensed behavioral health clinician (ie, LICSW, LPCC,...within insurance or health care setting in case/disease or utilization management * Bachelor's or Master's degree… more
- Pacific Medical Centers (Renton, WA)
- …The Supervisor Care Management RN is responsible for the supervision of case management (CM) and utilization management (UM) functions of US Family ... and processed in a timely manner. It includes timely review of medical necessity and authorization for all admitted...USFHP Medical Director(s) to develop and implement strategic case management and utilization management yearly… more
- Community Health Systems (Naples, FL)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... Dental, Vision) **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... delivery and quality of patient care. A hospital-based case management system has as its primary goal to ensure...team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and… more
- Montrose Memorial Hospital (Montrose, CO)
- …the medical care provided. This position combines the unique skill sets of the Utilization Review Nurse and Clinical Documentation Specialist to facilitate ... Montrose, CO, USA | Case Management | Hourly | 36.17-57.87 per hour 36.17...experience preferred; and one (1) to two (2) years Utilization Review experience preferred. What We Offer:… more
- Nuvance Health (Danbury, CT)
- …with CMS, Joint Commission, and other regulatory bodies related to discharge planning, utilization review , and care transitions. 6. Monitor and analyze key ... - One of America's 50 Best Hospitals * Surgical Review Corporation (SRC) - Robotic Center of Excellence *...special place to work. Summary: The Director of Case Management provides strategic leadership and operational oversight for the… more