- HCA Healthcare (Kissimmee, FL)
- …and admission status issues through established chain of command. + Performs utilization management reviews and communicates to third party payors. + ... supporting a balance of optimal care and appropriate resource utilization . Identify potential barriers to patient throughput and quality...Bachelor's in Nursing + 1+ year of prior case management experience + Registered Nurse - Currently… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization Management experience + Experience working in the health plan industry… more
- RWJBarnabas Health (New Brunswick, NJ)
- …1 to 2 weeks in advance for potential conflicts or issues, Patient Care Management Monitors the quality of service and utilization standards and assumes general ... years of related departmental experience required Two years of progressive management experience in related field preferred Certifications Licenses Registered … more
- Penn Medicine (Lancaster, PA)
- …license and daily access to an insured vehicle. Preferred Qualifications + Knowledge of Utilization review or managed care + Experience with home visits + ... management platform/analytics. + Analyzes data to identify under/over utilization ; improve resource consumption; promotes potential reduction in cost and… more
- Highmark Health (Pittsburgh, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications** : + Knowledge and experience with ... (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely...of care. Utilizing experience and skills in both case management and utilization management , the… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with MCG ... (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely...of care. Utilizing experience and skills in both care management and utilization management , the… more
- State of Massachusetts (Boston, MA)
- …placement along the continuum of care. This vital role encompasses Utilization Review , Performance Improvement, Risk Assessment, Infection Surveillance, and ... a general summary and not all inclusive):_**__*/* * /Oversee case coordination, utilization review , discharge planning, and resource allocation across assigned… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions provides Utilization Review / Case Management / Medical Management /Claims Review services to its clients. ... Care Coordinators facilitate care management and utilization review by...data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regards to… more