- AdventHealth (Tampa, FL)
- …or Social Worker: BSW Masters in related field. 3 years in direct Care Management / Utilization Management experience in an acute care setting. State specific ... work life balance **The role you'll contribute:** The Care Management Manager is under the general leadership of the...RN license if a nurse . This facility is an equal opportunity employer and… more
- AdventHealth (Sebring, FL)
- …or Social Worker: BSW Masters in related field. . 3 years in direct Care Management / Utilization Management experience in an acute care setting. . State ... and hiking trails **The role you'll contribute:** The Care Management Manager is under the general leadership of the...specific RN license if a nurse . . Licensed Social Worker (LSW) This facility is… more
- Mohawk Valley Health System (Utica, NY)
- …+ 3 years of clinical experience. + Strong computer skills. PREFERRED: + Case Management , Utilization Management and Quality Management experience ... Transitional Care RN - Case Management - Full Time - Days Department: CASE...+ Coordinate processes designed to reduce readmissions with physicians, nursing staff, the patient and care givers. + Implement… more
- UNC Health Care (Eden, NC)
- …7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely ... comprehensive care manager assessments utilizing standardized assessment tools and nursing knowledge to evaluate patients' functional abilities, cognitive status,… more
- LA Care Health Plan (Los Angeles, CA)
- …the claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter ... Payment Integrity Nurse Coder RN III Job Category: Clinical Department:...inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal… more
- Hawaii Pacific Health (Honolulu, HI)
- …long term care, or related field. **Preferred Qualifications:** Current Case Management or Utilization Management certification. EOE/AA/Disabled/Vets Hawai'i ... ID** 30598 **Pay Range:** 127,691 - 159,619 USD per year **Category:** Nursing **Minimum Qualifications:** Current Hawai'i Registered Nurse license. Bachelor's… more
- Sutter Health (Burlingame, CA)
- …leading innovative case management programs. + 8 years experience in utilization management and discharge planning. + 8 years leadership experience in ... state regulations and guidelines. Has frequent contact with the Administrative Team, Nurse Executives and Directors, Risk Management & Ethics staff, Ancillary… more
- AdventHealth (Celebration, FL)
- …documents avoidable days, and facilitates progression of care. Collaborates with Utilization Management staff for collaboration on patient status changes ... State of Florida or multistate license as a Registered Nurse + 2 years of medical/ hospital nursing...+ Health-related masters degree or MSN + Prior Care Management / Utilization Management experience +… more
- Providence (Beaverton, OR)
- …Coordinated Care Organizations, Medicare and Medicaid regulations and care or utilization management functions + Experience includes Lean principles, ... we must empower them._** **Providence Health Plan is calling a Care Management Clinical Support Coordinator who will:** + Be responsible for performing duties… more
- St. Luke's University Health Network (Allentown, PA)
- …hospital setting required. + Prefer minimum of 2-5 years' experience in case management and/or utilization management . + Prefer financial experience related ... patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials...+ Must be a graduate of an accredited, professional nursing program. + Must have current RN license to… more