- 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
- Villa of Hope (Rochester, NY)
- …coordinator, providers, director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and when needed ... JOB TITLE: Intake Coordinator- RN/ Evening DEPARTMENT/PROGRAM: Medical Services SUPERVISOR: Nurse Manager/Health Coordinator PAY GRADE: 82 FLSA STATUS: NON EXEMPT… more
- Trinity Health (Livonia, MI)
- …of clinical experience in nursing and recent (within 2 year) experience in utilization review / management /discharge planning or case management . Current ... Care Team as a** **Case Manager** **in the Case Management Department awaits YOU ** **_Trinity Health Livonia_** is...criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of… more
- Community Health Systems (Tucson, AZ)
- …and administration of the activities of clinical review , discharge planning, resource utilization and utilization review . Acts as a liaison between ... **Part Time position , working Day shift Weekends in Care Management / Case Management at Northwest Medical Center in Tucson, AZ** **$2500 sign on bonus offered… more
- Veterans Affairs, Veterans Health Administration (Bonham, TX)
- …The Advanced MSA coordinates with patient coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic ... in the reports that are being provided to upper management and/or outgoing sources. Enters information such as clinic...Advanced MSA coordinates with the patient care team to review the clinic utilization by using various… more
- Health Care Service Corporation (Albuquerque, NM)
- …practice in state of operations + 3 years clinical experience, including 2 years utilization review or case management experience + Quality improvement ... Professional Health Care Quality (CPHQ Certification) + NCQA/CMS Auditing experience + Utilization Management background + Knowledge of Millman Care Guidelines… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more
- CVS Health (Phoenix, AZ)
- …experience as a Registered Nurse (RN). + 2+ years of experience in utilization management . + Active, current, and unrestricted RN licensure in state of ... key business areas. + May develop/assist in development and review new training content. + May collaborate/deliver inter and...Nurse (RN). + 5+ years of experience in utilization management . + Bachelor's degree in Nursing… more
- Penn Medicine (Philadelphia, PA)
- …be a seasoned med/surg nurse with a minimum of 5 years' experience in Utilization review and 3 years of experience in the Transfer Center. Summary: + ... hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management … more
- Stony Brook University (Stony Brook, NY)
- … Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...assigned. Identifies, follows and documents Avoidable delays in Care Management Program. Reviews and documents on patients who were… more