- Cedars-Sinai (CA)
- …reporting to the TPL carrier of all injured worker cases receiving case management services. + Ensures appropriate utilization of medical services within the ... Doing** The Case Manager is responsible for the case management of patient while hospitalized and upon discharge from...of care. Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor… more
- Nuvance Health (Danbury, CT)
- …for providing strategic leadership and operational oversight for a team of utilization review staff, denials and appeals specialists, non-clinical support staff ... *System Care Coordination Leader* will be responsible for leading a team encompassing utilization review and denials/ appeals specialists and will need to foster… more
- International Medical Group (Indianapolis, IN)
- …large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured,… more
- Crouse Hospital (Syracuse, NY)
- … of the RN Care Managers in the department, including Utilization Management , Discharge Planning and Denials and Appeals functions. + Assessing workflow ... Manager who is responsible for providing day to day management of the RN Care Managers in the department....Care Coordination Manager Requirements: + Licensed as a Registered Nurse in New York State + Bachelor's degree +… more
- Brockton Hospital (Brockton, MA)
- … program that enhances the quality of patient care while optimizing resource utilization . Provides training to staff on case management methods and techniques. ... systems, plans and develops reports that clearly monitor all areas of utilization /case management . Provides data, guidance and input on the development… more
- Rush University Medical Center (Chicago, IL)
- …in an overturned denial or has escalated through the proper channels. 5. Assist Utilization Management on implementing a strong process that will help prevent ... case. **Summary:** This position reviews initial clinical denials, document appeals for clinical inpatient denials, conducts appeals ...2 years of experience with hospital denial or case management or nurse audit. * Knowledge of… more
- Mount Sinai Health System (New York, NY)
- …are not limited to: a. Reviews all new admissions to identify patients where utilization review, discharge planning, and/or case management will be needed using ... **Job Description** **RN/Case Manager MSH Case Management PT Days** The Case Manager (CM) will...length of stay (LOS), improved efficiency, quality and resource utilization . Assignment will be by units/clinical areas of practice… more
- Sharp HealthCare (La Mesa, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... as Allscripts.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Molina Healthcare (AZ)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- UPMC (Pittsburgh, PA)
- …services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This role also acts as a SME for the department in ... representing management in meetings, training new staff and auditing peers....not limited to analysis of controlled substance prescribing and utilization to identify potential clinical care issues; prepayment review… more