- Community Health Systems (Siloam Springs, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities under the… more
- Community Health Systems (Bentonville, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... place to live! **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse, Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures ... within the Utilization Management (UM) program to maximize efficiency, ensure compliance and optimize patient care and safety. This position supports … more
- CVS Health (Jefferson City, MO)
- … team and utilization management team. * The Care Management Associate will review eligibility and benefits and open pre-certification cases and ... either approve or send to nursing staff for review . * The Care Management Associate role include: * Responsible for initial review and triage of Care Team… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …an Associate's Degree and a minimum of 2 years of experience in Utilization Management , Referral Management , Authorization/Denials, or Medical Claims ... to non-network providers to TRICARE Service Center for medical necessity/appropriateness review . + Routinely monitors referral management voicemail to ensure… more
- UPMC (Pittsburgh, PA)
- …The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services and assessment of member's barriers to ... Are you a registered nurse with a background in utilization management ? UPMC Health Plan is looking...information obtained from interaction with members and providers. + Review and document clinical information from health care providers… more
- UPMC (Pittsburgh, PA)
- …of medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including ... policies of the Health Plan. Contributes to process improvement within the Utilization Management department. + Participates in activities to support policy… more
- CVS Health (Austin, TX)
- …management team and utilization management team. The Care Management Associate will review eligibility and benefits and open pre-certification cases ... all with heart, each and every day. **Position Summary** The Care Management Associate (CMA) supports comprehensive coordination of medical services that include… more
- Sutter Health (Oakland, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness… more