- WellSpan Health (Mount Gretna, PA)
- …of alternative treatment settings to provide appropriate care. + Coordinate with Case Management as indicated. + Participates in the review of policy and ... through monitoring patient outcomes. Assists with the collection and analysis of utilization patterns including avoidable days and denied cases; shares this with… more
- CenterWell (Indianapolis, IN)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities in care, ... precise + Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving...of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and… more
- BayCare Health System (Sarasota, FL)
- …education regarding the Emergency Management program for office and agency staff. + Participates with Case Manager on initial Plan of Care review with a focus on ... area of responsibility. + Ensure quality assurance program and utilization review is followed in accordance with Home Care...quality, utilization and individual patient care goals. + Knowledge of… more
- Children's Home Healthcare (Amarillo, TX)
- …VALID RN LICENSE* Children's Home Healthcare is now hiring for an RN Clinical Supervisor/ Case Manager ! Children's HH is the premier leader in Pediatric Home ... for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional Services.… more
- Elevance Health (Miami, FL)
- …and/or medical policies. May collaborate with healthcare providers. Focuses on relatively complex case types that do not require the training or skill of a ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- Elevance Health (Seven Fields, PA)
- …with providers and external physicians. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss ... state or territory of the United States when conducting utilization review or an appeals consideration and cannot be...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- CenterWell (Daytona Beach, FL)
- …in patient experience, quality of care, clinical outcomes, and avoidable utilization *Periodically review clinician charts to identify opportunities in care, ... coaching initiatives are precise *Identify critical issues for high-risk patients during case reviews & other forums, and modeling and driving clinical excellence… more
- St. Luke's University Health Network (Quakertown, PA)
- …clinical mental health/crisis intervention experience required. Previous experience with case management/ utilization review and managed care models preferred. ... may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and consults.… more
- Boston Health Care for the Homeless Program (Boston, MA)
- …health care, from preventative dental care to cancer treatment. Our clinicians, case managers, and behavioral health professionals work in more than 30 locations ... follow-up assistance when necessary + Work closely with the Manager of Patient Intake & Benefits Enrollment to implement...their insurance plans and offer education and resources on utilization of plan benefits, including SSI, SNAP, WIC, EITC,… more
- UNC Health Care (Kinston, NC)
- …the health and well-being of the unique communities we serve. **Summary:** The Manager provides efficient and effective delivery of patient care through case ... family and patient involvement to enhance awareness of length of stay, resource utilization and principles of patient care. Functions on a highly interactive level,… more