- UCLA Health (Los Angeles, CA)
- …care experience post residency, required + Minimum of 2 years of experience in Utilization Management + 2 or more years of experience working managed care ... + Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case management + Ability to lead and influence in a… more
- HCA Healthcare (Cypress, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- Trinity Health (Livonia, MI)
- …in terms of quality, safety, service, affordability, and technology. Oversees drug utilization management efforts; manages the pharmaceutical supply chain; and ... including new services/programs, revenue enhancement, expense reduction, managed care utilization systems, and strategies. Responsible for ensuring performance excellence… more
- AON (Houston, TX)
- …and ability to work with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven environment that ... to work with others. + Experience in resource deployment and utilization management . + Successfully operates in a fast-paced driven environment that requires… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... and the Manager regarding variances, aspects of patient care management . + Facilitates insurance authorization, pre-certification, and concurrent reviews for… more
- Molina Healthcare (Sparks, NV)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... attitude for success **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). RN licensure preferred… more
- Catholic Health Services (West Islip, NY)
- …CH HAC Meeting, Hospital Performance Improvement and Patient Safety Committee, and Utilization Management Committee. + Participate in the development and ... of stay. + Participate in and serve as a physician resource for Risk Management activities and processes, such as Root Cause Analyses, to review and monitor the… more
- Humana (Jefferson City, MO)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review organization,… more
- Genesis Healthcare (NM)
- …and development of area medical directors, the assurance of effective quality and utilization management , and the successful transition within area centers to a ... are actively engaged, effective, and successful in center-based quality and utilization management , regulatory compliance, IT/EHR implementation, and business… more
- Penn Medicine (Princeton, NJ)
- …Effective and timely completion of pre-certifications as well as coordination of utilization reviews with utilization management reviewer. Timely and ... plan development and coordination, referent relations, discharge planning, and case management with social service support systems, schools and other relevant… more