- US Tech Solutions (Columbia, SC)
- …Promotes enrollment in care management programs and/or health and disease management programs. + Provides telephonic support for members with chronic ... established clinical criteria to service requests or provides health management program interventions. **Responsibilities:** + Utilizes clinical proficiency and… more
- Corewell Health (Grand Rapids, MI)
- … leadership, coordinates the educational plan for the Behavioral Health, Care Management , and Utilization Management departments. Stakeholders include staff, ... Registered Nurse OR Social Worker Scope of work: In...Reports to either a Director of Behavioral Health, Care Management , or Utilization Management with… more
- CVS Health (Jefferson City, MO)
- …include intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. * The Care ... each and every day. **Position Summary** Must live/work in PST The Care Management Associate (CMA) supports comprehensive coordination of medical services that… more
- CVS Health (Austin, TX)
- …intake and outgoing calls for medical services. We work closely with both case management team and utilization management team. The Care Management ... it all with heart, each and every day. **Position Summary** The Care Management Associate (CMA) supports comprehensive coordination of medical services that include… more
- Cedars-Sinai (CA)
- …established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... America's Best Hospitals! **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates care of the patient from pre-hospitalization… more
- Cedars-Sinai (Marina Del Rey, CA)
- …established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... Employee Referral Bonus **What You Will Do in This Role:** A Registered Nurse Case Manager plans and coordinates care of the patient from pre-hospitalization through… more
- Nuvance Health (Danbury, CT)
- …in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum ... *Description* *Summary:* The purpose of the Denial Prevention Nurse is to ensure that all patient admissions...the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care… more
- University of Southern California (Los Angeles, CA)
- …of specific patient populations. The role integrates the functions of complex case management , utilization management , quality management , discharge ... status and processing of requests received from ambulatory care management nurse . 8. Assesses ongoing discharge planning...years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the… more
- ERP International (Macdill AFB, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... ** Nurse (RN)** for Full-Time positions in **Case Management ** at MacDill AFB, FL. Apply online today and...and implement local strategies using inpatient, outpatient, onsite and telephonic CM * Develop and implement tools to support… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …bilingual Spanish speaker * 1+ years of managed care experience; eg case management /health coach, utilization management and/or auditing experience. * ... across the continuum of care by leveraging member partnership, pre-service clinical utilization review, case and disease management processes, skill sets and… more