- Elevance Health (Washington, DC)
- …with providers, claims or service issues. + Assists with development of utilization /care management policies and procedures, chairs and schedules meetings, as ... **Pediatric Nurse Case Manager Sr** **Location:** Washington, DC. This... Case Manager Sr** will be responsible for care management within the scope of licensure for members with… more
- Dignity Health (Gilbert, AZ)
- …and Responsibilities** Under the general direction of the Director of Care Management , performs criteria-based concurrent and retrospective utilization review to ... admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of… more
- Trinity Health (Berwyn, IL)
- …for an experienced Authorization Referral Coordinator. Reporting to the Manager of Utilization Management and working under general supervision, manages ... the clinical team per protocol. Refers requests to the nurse reviewer or medical director if criteria or guidelines...and assist with in-network referrals. + Escalate requests to nurse reviewers or medical directors when guidelines are not… more
- SSM Health (Midwest City, OK)
- …opportunities for improvement in standard work. + May also be responsible for: utilization management process, ED case management process, admission process, ... Midwest **Worker Type:** Regular **Job Highlights:** **Department:** System Case Management **Schedule:** The schedule for this role will be...department's Scope of Service. + As an SSM Health nurse , I will demonstrate the professional nursing … 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
- Intermountain Health (Murray, UT)
- …Case management Certification. - and - Experience in Case management , Utilization review, and/or discharge planning. **Physical Requirements:** Ongoing need ... **Job Description:** The Nurse Case Manager utilizes clinical expertise and critical...in area(s) of responsibility. Completes documentation as required. Performs utilization review activities to provide patient appropriate, timely, and… more
- MTC (Chaparral, NM)
- …by Chronic Care Clinic Heath Standards. 13. Practice basic cost containment and utilization management techniques. 14. Keep work area neat and organized. 15. ... + Paid Holidays Make a difference in health care! **Operated by the Management & Training Corporation, Otero County Processing Medical Facility in Chaparral, New… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Participates in HomeCare and interdepartmental Performance Improvement, Quality Control and Utilization Management projects. Participates in HomeCare and RCHC ... clinical and technical support to the pharmacy technicians, HomeCare nursing staff, physicians, and patients/caregivers. Ensures safe storage, compounding,… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …of care for patient admission. Assist with Patient Placement Center and Utilization Management to perform admission status appropriateness by collaborating with ... RN or LPN required. Must possess a degree in nursing , with preference given to a bachelor's degree. +...MD, Patient Placement Coordinator, and Utilization Review Coordinator. Complies with guidelines, institutional policies and… more