- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Intermountain Health (Las Vegas, NV)
- …Care Management I leads and collaborates with care management operations across utilization review , acute and emergency department care, and ambulatory/community ... Qualifications** + Previous management experience in hospital care management, utilization review , ambulatory care management, ambulatory utilization… more
- Saint Francis Health System (Tulsa, OK)
- …also participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...improvement of internal processes. Provides staff education as needed to further the goals of… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
- Henry Ford Health System (Troy, MI)
- …accreditation by NCQA and compliance with CMS and privacy policies. + Provides Utilization Management staff support and liaison support to committees, including ... GENERAL SUMMARY: Under the direction of the Utilization team manager to provide administrative, operational, and organizational support for the Utilization … more
- UCLA Health (Los Angeles, CA)
- Description At UCLA Health, the Utilization Management (UM) Review Nurse plays a vital role in ensuring the delivery of high-quality, evidence-based care. ... documentation related to prior authorization requests for medical services. The UM Review Nurse applies clinical judgment, regulatory standards, and established… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- UHS (Norwich, NY)
- …Health Services (UHS) Chenango Memorial Hospital is seeking a compassionate and skilled Staff Registered Nurse (RN) or Graduate Nurse (GN) dedicated ... treatment. You will uphold all professional standards, including the New York State Nurse Practice Act and UHS policies, while fostering a caring and healing… more