- Hartford HealthCare (Manchester, CT)
- …Region serves a region of 300,000 people in 19 towns. POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician ... accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing...in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- Point32Health (MA)
- … and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical Screening ... Point32Health (https://www.point32health.org/) . **Job Summary** Under the supervision of the Utilization Management Supervisor, the Behavioral Health (BH) … more
- Houston Methodist (Houston, TX)
- …oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible for ... initiatives. + Provides strategic vision and execution for case management and utilization review across all hospitals and central departments. Establishes… more
- Ventura County (Ventura, CA)
- …direction, the Senior Medical Management Nurse is responsible for performing utilization review , case management , and quality improvement functions to ... in Case Management , Disease Management , Quality Assurance, HEDIS and/or Utilization Review . NECESSARY SPECIAL REQUIREMENTS + Must possess and maintain a… more
- Elevance Health (Mendota Heights, MN)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** This role enables associates to...required. **Preferred Skills, Capabilities and Experiences:** + Familiarity with Utilization Management Guidelines is preferred + ICD-9… more
- Brockton Hospital (Brockton, MA)
- … management experience Proven experience in coordinating discharge planning and utilization review experience required. Prior management experience ... delays through problem resolution and follow-up. Monitors on-site case managers and utilization review staff to ensure compliance with Signature Healthcare… more
- Guthrie (Sayre, PA)
- …experience: five (5) years of experience in an acute care setting with strong care management , utilization review , and payer knowledge. A Case Management ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
- Evolent (Madison, WI)
- …Reviewer , Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Will Be Doing:** + Serve as the Physician Clinical Reviewer for Interventional Pain Management , reviewing cases... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to coverage decisions and final determinations regarding coverage in the BCBSMA utilization management system (MHK), so that decisions and medical reasoning ... request of the Senior Medical Director of the Physician Review Unit (PRU), the reviewer also provides...practice in order to process appeals + Experience in Utilization Management in a managed-care or risk… more