- Magellan Health Services (Carlsbad, NM)
- …Magellan Credentialing criteria. 2+ years' post-licensure clinical experience. Experience in utilization management , quality assurance, home or facility care, ... Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation,… more
- Stanford Health Care (Redwood City, 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
- Molina Healthcare (Madison, WI)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... software program(s) proficiency. Preferred Qualifications * Certified Professional in Healthcare Management (CPHM). * Recent hospital experience in an intensive care… more
- Spira Care, LLC (Kansas City, MO)
- …Medical Policies re: coverage and medical necessity + participation in key utilization management activities (ex: peer-to-peer consultations with health plan ... practices. + Clear, complete, and timely clinical documentation in EMR per risk management and Spira Care policy. + Participation in activities aligned to reducing… more
- CommonSpirit Health (Lakewood, CO)
- …discretion, and independent judgment in assessing/reassessing, facilitating care coordination, utilization management , and patient advocacy. + Assure medical ... Applicable State of Employment required + 1 year of nursing or case management experience required. + Experience working with EMR preferred. + Working knowledge of… more
- Corewell Health (Royal Oak, MI)
- …coordinating patient discharge planning for post-acute services, length of stay (LOS) management and utilization management ; collaborating to include ... coordination as evidenced by metrics, optimizing performance and adoption of best practice. Serves as a leader and resource for the health care team. Integrates new knowledge and evidence-based research into clinical practice. This position reports to the… more
- CommonSpirit Health (Garden City, KS)
- …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
- Johns Hopkins University (Baltimore, MD)
- …advisors as needed. + Collaborate with nurses, social workers, case managers, utilization management nurses, clinical pharmacists, pharmacy extenders and other ... activities include: Teaching services, direct care services, consultative activities, co- management services, complex care services, , the intermediate medical care… more
- Waystar (Atlanta, GA)
- …environment. + Familiarity with healthcare revenue cycle, clinical documentation improvement (CDI), utilization management , or related domain is a plus. + Strong ... degree (or equivalent experience). + Several years of experience in customer success, account management , or client services in a SaaS and preferably healthcare-tech… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
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