- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …and a web based application for daily entry of case activity and the utilization management of service authorizations. 2+ years' experience serving at risk ... case plan outlining family needs, goals and services. Service Utilization UM/Wrap: This is strongly recommended in order to...in order to manage and track the daily service utilization log, monitors costs and tracks 3rd party resources.… more
- US Tech Solutions (Columbia, SC)
- …+ Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... clinical guidelines. + Provides support and review of medical claims and utilization practices.. **Responsibilities:** + May provide any of the following in support… more
- Centene Corporation (Springfield, IL)
- …as some experience in each of the following areas: acute care, utilization management (UM), InterQual knowledge, and discharge planning knowledge. **Additional ... plans, and actions taken on member medical records in health management systems according to utilization management policies and guidelines + Works with… more
- Catholic Health Initiatives (Bismarck, ND)
- …Team:** + **Clinical Acumen:** Leverage your medical expertise to guide utilization management , focusing on accurate level-of-care determinations and efficient ... and/or other leadership experience in acute care settings with focus on utilization management and quality assurance and improvement. + Utilization … more
- HCA Healthcare (Kissimmee, FL)
- …caregivers, case management , and admitting departments to promote effective utilization management through coordination of efforts involving patient flow. ... the patient flow program effectiveness as it relates to utilization review, resource management , and discharge planning...as it relates to utilization review, resource management , and discharge planning and care coordination. + Establish… more
- Sutter Health (San Francisco, CA)
- …Center Davies **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's accepted ... necessity is met and at the appropriate level of care. Coordinates the utilization management , resource management , discharge planning, post-acute care… more
- Corewell Health (Grand Rapids, MI)
- …support of medical management + Provide clinical oversight to nurse case management and utilization management . + Promote and advocate for ... education skills; evaluation of evidence-based standards of care and application of utilization management skills and strategies. Preferred + LIC-Physician (MD)… more
- Rochester Regional Health (Rochester, NY)
- …efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other ... 3 years acute hospital care experience not required. PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience preferred. + Bachelor's… more
- CVS Health (Phoenix, AZ)
- …+ Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Evaluation of Members; Through the use of ... of patients? Join Mercy Care as a Analyst, Case Management and become part of a mission-driven team that's...care management tools and information/data review, conducts comprehensive evaluation of… more
- Centene Corporation (Sacramento, CA)
- …or medical group experience, provider relations, quality improvement, claims, contracting utilization management , or clinical operations. Project management ... align on network performance opportunities and solutions, and consultative account management and accountability for issue resolution. Drive optimal performance in… more