- Independent Health (Buffalo, NY)
- …a current and accurate database. + Provide high quality, professional utilization management services: (medical necessity review for Prior Authorization, ... and concurrent review). + Prompt, courteous, and error free in performing utilization management functions. + Maintain quality of reviews and documentation… more
- Veterans Affairs, Veterans Health Administration (Tuscaloosa, AL)
- …knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care ... registration will meet the requirement for graduation from an approved school of professional nursing to warrant an appointment as a Nurse who has completed an… more
- Rochester Regional Health (Rochester, NY)
- …efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other ... in daily Huddles, providing ongoing communication to the Charge Nurse and Nurse Manager to address complex...hospital care experience not required. PREFERRED QUALIFICATIONS: + Case Management or Utilization Management experience… more
- McLaren Health Care (Flint, MI)
- …departmental policies and procedures as well as documentation of the case management and utilization management processes. Responsible to collaborate ... organizational goals. Assumes responsibility for the clinical administrative aspects of utilization review and case management . Integrates medical management… more
- Ellis Medicine (Schenectady, NY)
- …Services discharge planning guidelines and departmental/organizational policies and processes + Utilization Management : + Ensures order in chart/EMR coincides ... the Case Manager include, but are not limited to, utilization review, case management , care transition, collaboration...+ Current license or valid permit to practice professional nursing in the state of New York + Associate's… more
- HCA Healthcare (Richmond, VA)
- …and concurrent review for all payers and maintains legible documentation as directed by the Utilization Management Plan + As a member of Case Management team ... **Job Summary and Qualifications** As a Case Manager Registered Nurse (RN), you will provide direct nursing ...experience as RN years demonstrated leadership experience + Commercial Utilization Management and/or Case Management … more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- UPMC (Washington, PA)
- …care/treatment, The Joint Commission Standards, Federal/State regulations relative to utilization /case management , discharge planning, Medicare, Medicaid, and ... The Manager oversees the day-to-day operations of the Case management department under the direction of the Director. The Manager is accountable for the following… more
- Corewell Health (Grand Rapids, MI)
- …of medical management + Provide clinical oversight to nurse case management and utilization management . + Promote and advocate for patient-centered ... education skills; evaluation of evidence-based standards of care and application of utilization management skills and strategies. Preferred + LIC-Physician (MD)… more
- AdventHealth (Hinsdale, IL)
- …. BSN . Health-related Master's degree or MSN . Prior Care Management / Utilization Management experience **LICENSURE, CERTIFICATION OR REGISTRATION ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more