- State of Minnesota (Anoka, MN)
- …of treatment standards for mental illness and other disabilities. + Knowledge of utilization management principles, processes, and plans, as well as a ... fax and e-mail **Minimum Qualifications** Two (2) years of professional case management or social work experience, preferably within a hospital or community setting,… more
- Summit Medical Consultants LLC (Pueblo, CO)
- …and actively participates in medical staff duties. Participates in quality assurance, utilization management , and peer review programs to ensure high quality, ... Supports practice budgetary targets while maintaining standards of care. Participates in utilization and care management processes to ensure high quality,… more
- Beth Israel Lahey Health (Burlington, MA)
- …weekends. This position is on-site at Lahey Hospital and Medical Center. The Utilization Analyst works with physicians, the payers and inpatient case management ... medical necessity of the hospital care. Using the concepts of utilization review, clinical documentation improvement and revenue integrity, these specialized case… more
- Providence (Orange, CA)
- …hire: California Registered Nurse License. + 3 years Experience in Utilization Management . + Experience working with InterQual and MCG guidelines. ... **Preferred Qualifications:** + Master's Degree Nursing . + 5 years Experience as a utilization /case manager in an acute care setting. + Experience in a… more
- Molina Healthcare (AZ)
- …and cost-effective member care. The candidate must have Medicare Appeals and/or Utilization Management knowledge. Work hours are Monday-Friday 8:00am- 5:00pm ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Molina Healthcare (Dallas, TX)
- JOB DESCRIPTION Fully remote opportunity for a TX licensed RN with Utilization Management experience to join our Prior Authorization reviewing team. Previous UM ... to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required...equivalent combination of relevant education and experience. * Registered Nurse (RN). License must be active and unrestricted in… more
- Centers Plan for Healthy Living (Margate, FL)
- …Plan For Healthy Living is currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer ... or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests to… more
- Providence (Fullerton, CA)
- …California Registered Nurse License + 3 years of experience in Utilization Management . + Experience working with InterQual and MCG guidelines. **Preferred ... + Master's Degree in Nursing . + 5 years in experience as a utilization /case manager in an acute care setting. + Experience in a multi-hospital and/or integrated… more
- Elevance Health (NC)
- …supervision. **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad range of ... a related behavioral health field or a degree in nursing , and minimum of 3 years of experience with...preferred. + Bilingual in Spanish is highly preferred + Utilization Management experience is preferred + Previous… more
- Trinity Health (Mishawaka, IN)
- …As a Case Manager, you will oversee day-to-day coordination of care, utilization management , and discharge planning for assigned patient caseloads. You ... and supportive team approach **Highlights:** + Manage patient care coordination, utilization , and discharge planning + Collaborate with multidisciplinary teams to… more