- CVS Health (Trenton, NJ)
- …in Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management ) Medical Director will be a "Work from Home" position ... and appeal request. This position is primarily responsible for Utilization Management , including prior authorization as well...review. Cases could focus on inpatient or outpatient services, acute and post - acute services, pharmacy,… more
- Bon Secours Mercy Health (Greenville, SC)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... and assessment of individuals in need of active Case Management services and promotes the right resources, at the...clinical setting (required) 3 years of experience in an acute care clinical setting (preferred) Ambulatory or post… more
- AdventHealth (Denver, CO)
- …stay to ensure timely care coordination and progression of care, making arrangements for post - acute care services and facilities as well as community care for ... Worker is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient...follows standard work and best practices to communicate with post - acute care services and facilities to ensure… more
- Commonwealth Care Alliance (Boston, MA)
- …the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing ... program is responsible for providing care delivery and care management to a specific panel of high risk and...and PCP to close these gaps + Timely Medical post -hospital discharge with focus on hospitalization and utilization… more
- Bon Secours Mercy Health (Portsmouth, VA)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... and assessment of individuals in need of active Case Management services and promotes the right resources, at the...clinical setting (required) 3 years of experience in an acute care clinical setting (preferred) Ambulatory or post… more
- University of Utah Health (Salt Lake City, UT)
- …inpatient care in various areas of the hospital including intra-operative device management and post -operative preparation for discharge and follow-up needs. + ... Coordinates long term management and follow-up care for outpatients post ...to assist in obtaining procedural coverage approval. + Oversees utilization of MCS resources within the program's budget and… more
- Hartford HealthCare (Torrington, CT)
- …* Bachelor's degree in Nursing preferred. *_EXPERIENCE_* * Minimum of 3 years acute care hospital experience required. * Care Management experience preferred. * ... comprehensive healthcare network. Charlotte Hungerford Hospital is a 122-bed, general acute care community hospital located in Torrington, Connecticut, that serves… more
- Baylor Scott & White Health (Dallas, TX)
- …external independent providers - including physicians, hospitals, allied health professionals, post - acute and ancillary providers - as well as administrators, ... types, such as employed, independent, and hospital-based practices as well as post - acute providers. - Oversees the successful formulation, development, and… more
- Catholic Health Services (West Islip, NY)
- …hospital care management leadership role is required. + Experience in utilization management , working with managed care organizations, and discharge planning ... : + Works collaboratively with, but not limited to, Medical Staff, Quality/Risk Management , CH Utilization and Central Appeals, Managed Care and Revenue Cycle… more
- Covenant Health Inc. (Knoxville, TN)
- …links with Integrity Office, Coding, Transcription, Quality Management , Case Management , Utilization Management , Physician Advisors and KBOS. Customer ... feedback on program objectives. + Works closely with KBOS, PAG Physician Advisors, Utilization Management , Quality Management and Coding personnel to assure… more