- Elevance Health (Overland Park, KS)
- …with providers, claims or service issues + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as well as ... and functions as preceptor for new care management staff + Participates in audit activities and assists supervisor with management of day-to-day activities, such as… more
- Molina Healthcare (Tacoma, WA)
- …Access and Monitoring team responsible for prior authorizations and/or other utilization management activities aimed at providing Molina Healthcare members with the ... clinical and non-clinical team activities to facilitate integrated, proactive utilization management, ensuring compliance with regulatory and accrediting standards.… more
- GetWellNetwork, Inc. (Washington, DC)
- …Manager will take the Get Well program to the next level by driving nurse engagement, focusing on increased utilization , and leading projects of functionality to ... Facility. Get Well's Client Service Manager is responsible for effective product utilization and successful outcomes for the Get Well system at their designated… more
- LifePoint Health (Rutherfordton, NC)
- …adaptation and outcome of care management as prescribed in the initial Utilization Review Plan with regard to resources, appropriateness of care and adherence ... all staff in UR standards and LOS topics. Insures effective Utilization Review Process.1. Performs admission and concurrent medical record review.2. Documents… more
- Molina Healthcare (Worcester, MA)
- …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), case ... Collates and reports on Care Access and Monitoring statistics including plan utilization , staff productivity, cost effective utilization of services, management… more
- Elderwood (Liverpool, NY)
- …$29.00 - $37.70 / hourly Overview Elderwood at Liverpool is seeking a Licensed Professional Nurse to join our clinical team as a LPN MDS Nurse Assessor. LPNs, ... right skill set, will be considered as well. MDS Nurse Assessor - Position Overview: + An MDS ...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
- Highmark Health (Monroeville, PA)
- …relationships across the organization in a community setting. **GENERAL OVERVIEW:** Registered nurse who is proficient in the coordination of care and manages ... that supports excellence of care and achievement of optimal resource utilization . Also facilitates appropriate LOS, patient satisfaction and reimbursement for all… more
- Elderwood (Hamburg, NY)
- Salary Up to $49.50 / Hour Overview Elderwood at Hamburg is seeking a Registered Nurse (RN) to join our clinical team as a MDS Nurse . Position Overview: + An MDS ... (Minimum Data Set) nurse , or nurse assessment coordinator, collects and...State requirements, and facility policies. + Actively participate in utilization management processes, including PDPM and state case mix… more
- CenterWell (Houston, TX)
- …managing populations and coordinating care to reduce acute and post-acute care utilization . The Manager role is hybrid with travel requirements to preferred ... Duties and Responsibilities** + Oversees day-to-day operations, quality chart audit reviews, recruiting/hiring, team management, and overall performance for Care… more
- The County of Los Angeles (Los Angeles, CA)
- …goals. + Develops and implements reporting procedures to ensure that program services utilization and revenue data are reported accurately and in a timely manner. + ... review methods as necessary. + Oversees audits and the implementation of audit recommendations for programs managed. + Represents managed programs in meetings with… more