- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Humana (Raleigh, NC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Banner Health (AZ)
- …pre-service requests, provide case management , care coordination and perform utilization management duties within the appropriate time period as outlined ... health Plan consumer/beneficiaries' and providers with issues related to prior authorization, utilization management , and/or case management . Meets internal… more
- Select Medical (Lake Worth, FL)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- Select Medical (San Diego, CA)
- …functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management , discharge planning, ... focus on resource management . + Demonstrating compliance with facility-wide Utilization Management policies and procedures. + Coordinating UR compliance with… more
- ERP International (Luke AFB, AZ)
- … Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with social work… more
- Providence (Olympia, WA)
- …admissions. + **Physician Relations:** Build strong cooperative relationships with physicians. + ** Utilization Management Oversight:** Lead the Utilization ... setting. + **Leadership Experience:** Minimum 3 years managing care coordination. Utilization review knowledge preferred. + **Independent Leadership:** Proven… more
- Virginia Mason Franciscan Health (Burien, WA)
- …of the medical staff and take on the role as leader of the Hospital's utilization review / management committee, which is charged with adhering to regulatory ... RAC entities, or other agents as required * Participate in the utilization review / management committee, in defining operational strategic objectives for the … more
- Corewell Health (Dearborn, MI)
- …discharge planning of all hospitalized patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... years of relevant experience Three to five years' experience in care management , utilization review , home care and/or discharge planning. Preferred +… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more