- Penn Medicine (Lancaster, PA)
- …license and daily access to an insured vehicle. Preferred Qualifications + Knowledge of Utilization review or managed care + Experience with home visits + ... management platform/analytics. + Analyzes data to identify under/over utilization ; improve resource consumption; promotes potential reduction in cost and… more
- Highmark Health (Pittsburgh, PA)
- …including but not limited to: appropriateness of care, documentation requirements, utilization review principles and criteria, insurance benefits and ... effective resource utilization . Serves as key team members in the management of readmissions, length of stay, ED utilization , and patient/family… more
- HCA Healthcare (Dallas, TX)
- …federal regulation pertaining to federally funded programs as they relate to utilization review , discharge planning and financial reimbursement. + Conducts ... nurses play a vital part. We know that every nurse 's path and purpose is unique. Do you want...approval of patients in the Rehab unit. Manages the Utilization Review process and maintaining continued stay… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with MCG ... (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely...of care. Utilizing experience and skills in both care management and utilization management , the… more
- State of Massachusetts (Boston, MA)
- …placement along the continuum of care. This vital role encompasses Utilization Review , Performance Improvement, Risk Assessment, Infection Surveillance, and ... a general summary and not all inclusive):_**__*/* * /Oversee case coordination, utilization review , discharge planning, and resource allocation across assigned… more
- Dignity Health (Bakersfield, CA)
- …on clinical protocols. Essesntial functions include: - Communicate effectively and interact with the utilization review nurse and health plans daily or as ... and cost effectiveness of medical care through strict adherence to all Utilization Management (UM) Policies and procedures promptly, efficiently and accurately.… more
- MyFlorida (Fleming Island, FL)
- …operations including budget planning, revenue and expense monitoring, inventory management and purchasing. + Supervise clerical support staff, establishing clear ... clinic coverage. + Plans workloads, workflows, deadlines, work objectives and time utilization with employees. + Directs the work of employees to ensure best… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions provides Utilization Review / Case Management / Medical Management /Claims Review services to its clients. ... Care Coordinators facilitate care management and utilization review by...data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regards to… more
- Villa of Hope (Rochester, NY)
- …coordinator, providers, director of LHTC and administrative team, including billing and utilization review . + Triages potential admissions and when needed ... JOB TITLE: Intake Coordinator- RN/ Evening DEPARTMENT/PROGRAM: Medical Services SUPERVISOR: Nurse Manager/Health Coordinator PAY GRADE: 82 FLSA STATUS: NON EXEMPT… more
- Trinity Health (Livonia, MI)
- …of clinical experience in nursing and recent (within 2 year) experience in utilization review / management /discharge planning or case management . Current ... Care Team as a** **Case Manager** **in the Case Management Department awaits YOU ** **_Trinity Health Livonia_** is...criteria. Knowledge of federal, state and local regulation affecting utilization review programs and payments. Knowledge of… more