- Sharp HealthCare (Chula Vista, CA)
- …regulations. ICD-9, RVS, and CPT 4 coding. + Basic computer functions. + Basic utilization management . + Accurately type or on-line key 35-40 wpm. + Organize ... utilization .Informs appropriate leadership, staff, other departments and/or material management of case needs. + Department productionPatient/families are always… more
- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... high-risk cases to the appropriate FH internal teams (ie: Outpatient Case Management , NaviCare, ACO) and/or other community services according to department protocol… more
- Molina Healthcare (Yonkers, NY)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG… 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 of 4 ... members of the interdisciplinary care team * Current working knowledge of utilization management , performance improvement and managed care reimbursement. Working… more
- UCLA Health (Santa Monica, CA)
- …Nursing staff) + CA RN License and BLS certification + Recent experience in case management , utilization management and discharge planning + Minimum of three ... safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital care.… more
- Dartmouth Health (Keene, NH)
- …physician practice, while emphasizing care coordination across the continuum. Perform utilization management activities as necessary to ensure that medical ... research-based critical pathways and outcome measurement preferred. Experience in case management , utilization review and discharge planning preferred. Knowledge… more
- Highmark Health (Buffalo, NY)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review, status… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review. Ensures all accurate… more
- Molina Healthcare (North Las Vegas, NV)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines.… more
- Randolph Hospital (Asheboro, NC)
- …quality, cost effective, health care. Performs all aspects of discharge planning and utilization management for the patients in their assigned area, which will ... staff and medical staff on issues related to discharge planning and utilization management . Graduate from an accredited school of nursing, BSN preferred. Current… more
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