- 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
- BJC HealthCare (Alton, IL)
- …to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to ... care, rehabilitation, 24-hour emergency care, ambulance services and more. Case Management , Utilization Review, Social Services: Provides admission and continued… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …years nursing experience with advanced level pediatric clinical experience and utilization management and/or discharge planning experience. Thorough knowledge of ... managed care, utilization management , discharges planning, and continuous quality improvement concepts. Computer Literacy. Strong interpersonal and negotiation… more
- US Tech Solutions (LA)
- …a hospital setting in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong direct relationships with ... + Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : Utilization … more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health Care ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. + Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have experience… more
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