- Magellan Health Services (San Diego, CA)
- …manage and oversee activities of assigned care support teams. Experience with Care Management flows. Knowledge of utilization management procedures, mental ... appropriate and effective person-centered care plan, member education and care management . Conducts initial and concurrent review for prior authorization of higher… more
- Sharecare (Boston, MA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... the Family Health Advocate is an exciting and innovative remote role newly created to provide meaningful support to...+ Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex… more
- GE Vernova (Wilmington, NC)
- …but is not limited to commercial contracting, licensing, patent portfolio management , IP and proprietary information protection, and advisory work in connection ... Responsibilities** + Provide strategic advice, oversight and leadership in the management of the intellectual property (IP) and proprietary information of GVH… more
- Houston Methodist (Houston, TX)
- **Notes -** + **Selected candidate will work remote after completing onsite department training.** + **Selected candidate MUST reside in Greater Houston area.** At ... Houston Methodist, the Care Manager I position is a licensed registered nurse (RN) who works collaboratively with the interprofessional healthcare team to provide… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... plus specialized certifications as needed. Preferred Skills 3-5 years experience in Utilization Review, Case Management , and Clinical Appeals. 3-5 years of… more
- Sharp HealthCare (San Diego, CA)
- …VP for Clinical operations and Health Services to ensure timely submission of required Utilization , Case Management and Disease Management Work plans to ... Time** Bachelor's Degree in Nursing; Bachelor's Degree; Master's Degree; California Registered Nurse (RN) - CA Board of Registered Nursing; Certified Professional in… more
- Magellan Health Services (Bernalillo, NM)
- …Healthcare-related field, or relevant experience in lieu of degree., Experience in utilization management , quality assurance, home or facility care, community ... Experience in analyzing trends based on decision support systems. Business management skills to include, but not limited to, cost/benefit analysis, negotiation,… more
- AbbVie (Jacksonville, FL)
- …professionals regarding current and future therapies Responsibilities This role is considered remote but requires the employee to work within a reasonable distance ... recruitment, investigator meetings, external expert identification, and external collaboration management . + Serve as internal medical and scientific resource to… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management , utilization review and/or direct provider interaction experience, preferred. ... Health Care **What you will do** + Responsibility for management and optimization of the positive relationships between CDI...+ CCDS-O or CDIP . + Nursing\RN - Registered Nurse - State Licensure And/Or Compact State Licensure preferred… more
- Children's Mercy Kansas City (Kansas City, MO)
- …leadership, strategic planning, and oversight of daily operations of the case management department which includes utilization management , care progression ... Partners with Revenue Cycle, Payor Relations, HIM and Risk Management in support of utilization management...Workforce Engagement + Oversees and directs the work of Nurse Case Managers, Social Workers, and Utilization … more