- CommonSpirit Health (West Jordan, UT)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... two (2) years of acute hospital clinical experience or a Master's degree in Case Management or Nursing field in lieu of acute experience. + At least five years of… more
- Elevance Health (Roanoke, VA)
- …position. Preferred qualifications, skills, and experiences: + Previous experience in case management / utilization management with a broad range of experience ... with complex psychiatric/substance abuse cases preferred. + Independent licensure in Virginia is strongly preferred but not required. However, for states that do not require licensure a Board Certified Behavioral Analyst (BCBA) is also acceptable if all of the… more
- Penn Medicine (Plainsboro, NJ)
- …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In ... the multi-disciplinary care team to effect timely, appropriate patient management . 1. Addresses/resolves system problems impeding diagnostic or treatment progress.… more
- BJC HealthCare (St. Louis, MO)
- …to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to ... + At least 2 years of RN experience in pediatrics + Prior Case Management experience + BSN **Overview** **St. Louis Children's Hospital** is dedicated to improving… more
- Centene Corporation (Jefferson City, MO)
- …contract/network analysis, and/or ROI evaluation. Familiarity with claims payment, utilization management , provider/vendor contracts, risk adjustment for ... experience in working with large databases, data verification, and data management . Working knowledge of SQL/query languages. Preferred knowledge of programmatic… more
- University of Southern California (Las Vegas, NV)
- …patients with multiple low risk hospitalizations. + 15. Works with contracted utilization management company to discuss patients with complex diagnosis and/or ... refer high risk patients to appropriate specialty services, including assistance in management of home health needs. + 16. Performs other duties as assigned.… more
- Stanford Health Care (Palo Alto, CA)
- …area. + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance. + Knowledge ... this requirement for a given quarter, exceptions may be granted based on management 's discretion. **This is a Stanford Health Care job.** **A Brief Overview** The… more
- Northern Light Health (Presque Isle, ME)
- …will have an impact on the organization's ability to drive efficiency and utilization management , align both employed and independent medical staff to ... + Excellent verbal and written communication and presentation skills + Effective change management to lead change + High ethical and moral standards Why You'll Want… more
- Elevance Health (Los Angeles, CA)
- …services only, and there is licensed staff supervision. + Previous experience in case management / utilization management with a broad range of experience with ... complex psychiatric/substance abuse cases required. + Prior managed care experience required. **Preferred Skills, Capabilities, and Experiences:** + BCBA and LBA is STRONGLY PREFERRED For candidates working in person or virtually in the below location(s), the… more
- Elevance Health (NC)
- …supervision. **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad range of ... experience with complex psychiatric/substance abuse cases preferred + Bilingual in Spanish is highly preferred _For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and… more