- Catholic Health Initiatives (Bismarck, ND)
- …with family members, community resources, and other healthcare professionals. *Conducts utilization review : Act as a liaison with insurance companies ... **Job Summary and Responsibilities** Empowering Recovery: Registered Nurse (RN) - Partial Hospitalization Program (PHP) **Are...by completing utilization review to ensure coverage for the… more
- Catholic Health Services (West Islip, NY)
- …+ Ensures compliance with Hospital Conditions of Participation. + Implements care management programs, including utilization review , intake and discharge ... hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning… more
- Commonwealth Care Alliance (Springfield, MA)
- …Intensive Care (CIC) programing is responsible for providing care delivery and care management to a specific panel of high risk and complex people. This panel ... with significant medical, behavioral, and social complexities that require intensive care management and care delivery. Within the CIC Program, the Community Health… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill ... opportunities for connecting members to group related benefits; eg Nurse Line, Employee Assistance Program, or other specialists with...* 1+ years of managed care experience; eg case management /health coach, utilization management and/or… more
- Baylor Scott & White Health (College Station, TX)
- …for assessing and coordinating patient care across the continuum to include case management , social work, utilization review and care coordination to ... resolution **KEY SUCCESS FACTORS** Knowledge of Care Coordination, discharge planning, case management and utilization review . Knowledge of human behavior… more
- Texas Health Resources (Dallas, TX)
- …all available resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective ... management experience is preferred. * RN - Registered Nurse Upon Hire Req or LMSW - Licensed Master...according to department identified criteria to determine the appropriate utilization of resources and patient level of care. Reviews… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Part time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support...the facility's resources. 1. Current licensure as a Registered Nurse (RN) in the state of California is required.… more
- Providence (Everett, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... and be a part of something extraordinary!The Inpatient Registered Nurse (RN) Care Manager provides professional, comprehensive, patient centric...upon hire. + 1 year - experience in care management or utilization review in… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Bilingual - fluent in Spanish. ... of care. Utilizing experience and skills in both case management and utilization management including...care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more