- McLaren Health Care (Bay City, MI)
- …top decile performance in length of stay, cost efficient resource utilization , preventing readmissions and unnecessary emergency room visits. Works collaboratively ... D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. Reviews current DRG/LOS… more
- UPMC (Pittsburgh, PA)
- …healthy lifestyles, closes gaps in care, reduces unnecessary ER utilization and hospital admissions/readmissions, and manages social determinants of health. ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of care… more
- HCA Healthcare (Las Vegas, NV)
- …in operations, expense, clinical integration, quality, and service + Execute clinical utilization and expense management plans and ensure alignment with facility and ... National Product Standardization, Clinical initiatives and optimization of supply utilization through effective collaboration with physicians and clinicians +… more
- Wellpath (Franklin, TN)
- …you make a difference** The Regional Care Manager (RCM) is responsible for utilization review, care coordination, and daily care management across multiple sites and ... Manage pre-certification referrals for urgent, scheduled, and routine services including physician visits, procedures, imaging, and specialty care. + Coordinate care… more
- HCA Healthcare (Nashville, TN)
- …Lead the development and implementation of enterprise-wide product standardization, utilization management, and supply chain clinical integration strategies. + ... expert in value analysis, providing executive-level consulting to senior leadership, physician leaders, and clinical teams. + Cultivate strong relationships with… more
- Spectrum Health and Human Services (Buffalo, NY)
- …Care Coordinator will be responsible for the following outcomes: to reduce utilization associated with avoidable and preventable inpatient stays, to reduce ... utilization associated with avoidable emergency room visits, to improve...and improved health outcomes. + Consult with primary care physician and/or any specialists involved in the treatment plan.… more
- Northern Light Health (Bangor, ME)
- …measurement, monitoring, analysis, reporting, and adjusting the direction, allocation and utilization of available resources. + Collaborates with Physician Dyad ... Leadership to support program/practice changes to continually improve resource utilization . + Provides report of budget analysis to VP of Nursing at least quarterly.… more
- Saint Francis Health System (Tulsa, OK)
- …Clinic by sharing of reports and recommendations regarding how to reduce unnecessary utilization . Creates an environment of quality and cost improvement that is data ... driven and develops systems to review utilization of resources and objectively measure outcomes of care...with Warren Clinic leadership to assemble an 'Accountable Care' physician advisory panel to provide ongoing feedback to Saint… more
- University of Rochester (Rochester, NY)
- …Identifies problems that include but are not limited to pre-certifications, Utilization Management, Medicaid Pending, third party payer issues, and denials/appeal ... and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management, Medicaid Enrollment & Outreach, patients, families, third-party payers,… more
- Humana (Raleigh, NC)
- …scope. The Medical Director may speak with contracted external physicians, physician groups, facilities, or community groups to support regional market priorities, ... with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or… more