- Commonwealth Care Alliance (Boston, MA)
- … Home and Clinical teams to support consistency and quality across BH and Health Home providers. * Participate in case review meetings and rounds as needed to ... partnerships. This position works closely with CCA's Behavioral Health, Health Home , Network, and Clinical teams to ensure a seamless provider experience… more
- Wellpath (Franklin, TN)
- …or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge ... discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits...difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care… more
- UnityPoint Health (Des Moines, IA)
- …agencies and payers to plan and execute a safe discharge + Collaborate with Utilization Management team on continued stay review . + Collaborates with patients, ... continuity through elimination of fragmentation of care/service and facilitates the effective utilization of resources. Serves as educator and a central source of… more
- HCA Healthcare (Sun City Center, FL)
- …Healthcare Quality) OR CHCQM (Diploma in American Board of Quality Assurance and Utilization Review Physicians). _Individuals without CPHQ or_ CHCQM _will be ... protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage,… more
- Nuvance Health (Poughkeepsie, NY)
- …preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: Full-Time ... ER and Observation units Under the general supervision of the Director, The Nurse Case Manager role provide clinically-based case management to support the delivery… more
- Catholic Health Services (Roslyn, NY)
- …and monitors staff satisfaction. + Assures compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, ... to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St....reporting data on utilization trends, resource utilization and denials. + Serves as a resource to… more
- CareFirst (Washington, DC)
- …working in Care Management, Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with MCG ... our Onsite Clinical Navigator team. The Onsite Clinical Navigator ( RN ) embedded at a partnering hospital will conduct concurrent...) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely… more
- HCA Healthcare (Salt Lake City, UT)
- …sessions as well as conduct psychotherapy process groups. SW-MSW also perform utilization review functions, including conducting InterQual reviews and obtaining ... preferred. + 2 or more years of clinical experience preferred. + Knowledge of Utilization Review , DRG review , and Discharge Planning preferred. For 150… more
- Wellpath (Lemoyne, PA)
- …Care Management Certification. + RN preferred. Experience + Previous utilization review and/or case management and pre-certification experience + Knowledge ... memberships and product discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits varies based on… more
- Humana (Little Rock, AR)
- …requiring minimal instructions to achieve solutions. May provide coaching and/or review the work of lower-level associates. Makes decisions on moderately complex ... **Required Qualifications** + Bachelor's Degree in Business, Finance, Health Care/Administration, RN or a related field, or equivalent work experience + Experience… more