- Bon Secours Mercy Health (Kilmarnock, VA)
- …mandated by CMS and Conditions of Participation for discharge planning and utilization management . Addresses opportunities or potential concerns with leadership. ... and assessment of individuals in need of active Case Management services and promotes the right resources, at the...+ Identifies and prioritizes patients in need of care management services, using a holistic approach inclusive of biopsychosocial,… more
- MTC (Marion, OH)
- …the use of appropriate sanitation methods. 13. Practice basic cost containment and utilization management for patient care and facility operations. 14. Maintain ... + Civic duty and military leave Impact lives with Management & Training Corporation (MTC)! At the **North Central...and treatment orders and other emergencies. 4. Provide crisis management for disturbed patients 5. Assist with mental health… more
- Select Medical (St. Louis, MO)
- …allotted time frame; assuring payments of hospital-based services meeting patient-related utilization management criteria, and implementation of safe and ... of the discharge planning process. + The primary job functions in Case Management include: + Clinical Interventions/Discharge Planning + Care Planning Management … more
- State of Colorado (Pueblo, CO)
- …understood, actionable, and tied to CMHHIP's improvement goals. + Participate in utilization management and review activities when requested, applying clinical ... (accompanying surveyors throughout the hospital) and/or provides assistance to Quality Management Leadership as directed during regulatory surveys. May perform as an… more
- CDPHP (Latham, NY)
- …with Medicaid Long Term Care Programs preferred. + Minimum of two (2) years Utilization Management experience is preferred. + Experience with the New York State ... coordinating the care of CDPHP members who meet case management criteria across the continuum of care, ensuring and...serviced by CDPHP. Based on national standards for case management practice, the RN Case Manager will focus on… more
- CareFirst (Baltimore, MD)
- …leading large program initiatives in the healthcare domain such as EHR, care/ utilization management , or data warehouse platform migrations or product launches. ... requirements associated with the system sunsetting. + Stakeholder & Change Management : Partner with executives, business owners, technology leaders, PMO, and… more
- US Tech Solutions (Atchison, KS)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes...and education for members through the use of care management tools and resources. **Job Duties:** + Through the… more
- HCA Healthcare (Nashville, TN)
- …and evaluate changes in formulary strategy including exclusions, tier changes, and utilization management updates + Working knowledge of employee pharmacy ... member. + Meets member specific targets for contract performance, trend management , savings and strategic objectives. + Establishes productive, professional and… more
- Guthrie (Sayre, PA)
- …adherence to payer-specific appeal timelines and protocols + Collaborate with clinical, utilization management , billing, HIM, and coding teams to resolve medical ... The Denial, Appeal, and Audit Manager is responsible for the oversight and management of all payer denials, appeals, and audit processes within the health system.… more
- Sevita (Hayward, CA)
- …strategy to manage census, maintain occupancy, improve daily attendance, and/or maximize utilization + Financial Management + When applicable, approve purchase ... all every day. Join us today, and experience a career well lived. **Program Management - Program Director IDD Services Host Home** **Salary - $68,640 per year** Are… more