- Elevance Health (WA)
- …or equivalent. Requires a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... services in multiple states. **Preferred Skills, Capabilities and Experiences:** + Utilization Management and/ore Case Management experience strongly… more
- Community Health Systems (Naples, FL)
- …Management is responsible for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of ... review determinations. + Provides input into the utilization management program policies and procedures. +...Qualifications) + Minimum 2-3 years of experience in medical management , utilization review and case… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Coordination is responsible for system-wide Care Coordination functions ( Utilization Review , Social Work, Navigation, and Case Management ) including the ... management is required. + A minimum of five years of experience in care management or utilization review + A minimum of five to seven years of leadership… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... policies and procedures to determine clinical appropriateness. * Completes review of both medical documentation and claims data to...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more
- Sharp HealthCare (San Diego, 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
- Nuvance Health (Danbury, CT)
- …of hospitalization, LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities, resource ... of the healthcare industry. * Strong clinical acumen; Knowledge of Care Management / Utilization Review principles, processes, and their practical application.… more
- Evolent (Phoenix, AZ)
- …Stay for the culture. **What You'll Be Doing:** Job Description **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ... on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more