- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Admissions Liaison RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management (UM) Admissions Liaison RN II...but not limited to: Skilled nursing facility, outpatient needs ( home health, physical therapy, infusion), and case management… more
- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... expected to work a portion of their week from home and a portion of their week at a...medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care.… more
- Humana (Charleston, WV)
- …put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional who utilizes behavioral health ... communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional work assignments are… more
- AmeriHealth Caritas (Washington, DC)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... overtime, and weekends based on business needs. **Responsibilities:** + Conduct utilization management reviews by assessing medical necessity, appropriateness of… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- BayCare Health System (Tampa, FL)
- …Occasional + **On Call:** No **Certifications and Licensures:** + Required RN (Registered Nurse ) + Preferred ACM (Case Management ) + Preferred CCM (Case Manager) ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands of physicians.... Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse… more
- Veterans Affairs, Veterans Health Administration (Spokane, WA)
- …this occupational series. For more information, refer to Required Documents below. The Home Based Primary Care (HBPC) Program Director is accountable for the ... management , supervision and evaluation of care for patients enrolled...patients enrolled in the HBPC and other VA staffed in- home programs that are organizationally aligned under HBPC, which… more
- Veterans Affairs, Veterans Health Administration (Mcclellan, CA)
- … utilization . Demonstrates leadership in delivering and improving holistic, home -based care through collaborative strategies with others. Evaluates practice in an ... Summary The Home Based Primary Care-Outpatient Staff RN assesses, plans,...for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care.… more
- Veterans Affairs, Veterans Health Administration (Bedford, MA)
- …this occupational series. For more information, refer to Required Documents below Registered Nurse - Outpatient Home Based Primary Care position is located at the ... 40 hours per week. Responsibilities VA offers a comprehensive total rewards package: VA Nurse Total Rewards The Home Based Primary Care (HBPC) Outpatient Staff… more
- Veterans Affairs, Veterans Health Administration (Bath, NY)
- …Responsibilities Duties may include however, are not limited to the following: The Nurse Home Based Primary Care (HBPC) Outpatient Staff Registered Nurse ... utilization . Demonstrates leadership in delivering and improving holistic, home -based care through collaborative strategies with others. Evaluates practice in an… more
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