- 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
- Providence (Medford, OR)
- …based on population focus. Duties also include complex discharge planning and utilization review . Providence caregivers are not simply valued - they're ... 1 year Preferred home health, mental health, substance use, hospice, and/or utilization review . + Preferred progressive nursing leadership experience, including… 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
- Providence (Beaverton, OR)
- …in a medical record. + 2 years - HEDIS, Quality management /quality improvement/ utilization review auditing experience, including experience ... Health Information Management degree. + Experience with health plans, project management , data analysis, and/or case review . **Why Join Providence?** Our… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... **PURPOSE:** This position will support the Maryland government programs care management team, specifically the Medicare Advantage line of business. The Care… more
- University of Rochester (Rochester, NY)
- …Serves as the primary internal contact for national and state registry data management questions, issues or concerns, but not limited to clinical data collection, ... validation, delivery, reconciliation, and data management activity timeliness. Concurrently and retrospectively reviews medical records and data to identify patient… more
- Covenant Health Inc. (Morristown, TN)
- Overview Mgr. Quality and Care Management , Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Some local travel required. Flexibility for some late ... Excellence, women can have their annual mammograms, biopsies, and can meet with a nurse navigator if needed. The Women's Center offers six newly remodeled labor and… more
- YesCare Corp (Philadelphia, PA)
- …Engage in all quality improvement initiatives, including sentinel event reviews. + ** Utilization Review :** Participate actively in utilization review ... requested. + Participate in quality care reviews and sponsor physician assistants or nurse practitioners as needed. + **Schedule Management :** Notify the Site… more
- Molina Healthcare (Bronx, NY)
- …and cost-effective member care. Essential Job Duties * Performs audits in utilization management , care management , member assessment, behavioral health, ... care experience, with at least 1 year experience in utilization management , care management , and/or...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- HCA Healthcare (Overland Park, KS)
- …to Patient in Bed by facility by floor to identify opportunities + Assesses utilization of Bed Management technology for optimal use + Analyzes all aspects ... key role in division and facility Emergency Department and Bed Management process improvement projects by performing operational assessments and analyses,… more