- Kaleida Health (Buffalo, NY)
- …inpatient, outpatient, and the home health continuum, as well as managed care utilization management and coordination of care. Incumbent must maintain their ... profession (ie social work) preferred. Registered nurse license required. Case management certification preferred.** **Experience** **3-5 years in Utilization ,… more
- ERP International (Luke AFB, AZ)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health Services… more
- Dignity Health (Bakersfield, CA)
- …populations. This leader will have direct oversight of the Medical Director of Utilization Management (UM) and the Medical Director of Physician Engagement and ... and experience leading complex and innovative delivery models. + Experience in Utilization Management activities. + Strong communication skills, and ability to… more
- Providence (Olympia, WA)
- …admissions. + **Physician Relations:** Build strong cooperative relationships with physicians. + ** Utilization Management Oversight:** Lead the Utilization ... **The Role:** Under the supervision of the North Division Executive Director of Care Management , the Director of Care Management is a pivotal role responsible… more
- Point32Health (Canton, MA)
- …Develop comprehensive strategy to position Point32Health as a leader in utilization management and effectiveness, including pre-service, concurrent post-service ... (https://www.point32health.org/) . **Job Summary** The Vice President of Medical Management , reporting to the Senior Vice President, Health Care Services… more
- WellSpan Health (York, PA)
- …**Essential Functions:** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... support continuous quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and the treatment team regarding the… more
- Corewell Health (Royal Oak, MI)
- …of care and cost effectiveness through the integration and functions of utilization management , and/or care coordination, discharge planning, and appropriate ... Responsible for managing a case load of patients that includes facilitating utilization management , and/or care coordination during the patient's stay, planning… more
- WellSpan Health (Lebanon, PA)
- …**Duties and Responsibilities** + Reviews assigned patients for medical necessity, utilization management , and appropriateness of setting for continued ... support continuous quality and cost of care efforts. + Liaisons between utilization management team, third party payers, and the treatment team regarding the… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …The Physician Advisor will conduct clinical reviews on cases referred by case/ utilization management and/or other healthcare professionals in accordance with ... Hospital objectives related to quality care of patients, regulatory compliance, and utilization management (including LOS). 4. The Physician Advisor should… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more