- HCA Healthcare (Hendersonville, TN)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure...facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Molina Healthcare (Madison, WI)
- …and data analysts to produce tools to report, monitor and improve utilization management . * Actively participates in regulatory, professional and community ... organization (HMO) regulations, managed health care systems, quality improvement, medical utilization management , risk management , risk adjustment, disease … more
- Molina Healthcare (Columbus, OH)
- …or more of the following activities: care review , care management , utilization management (prior authorizations, inpatient/outpatient medical necessity, ... professionals in some or all of the following functions: care management , utilization management , behavioral health, care transitions, long-term services and… more
- WMCHealth (Valhalla, NY)
- …of quality and cost improvement that is data driven and develops systems to review utilization of resources and measure outcomes of care. Monitors physician data ... + Works with leadership team to support clinical documentation integrity and utilization management at the Medical Center. Qualifications / Requirements: +… more
- Molina Healthcare (AZ)
- …contributing to enterprise-wide strategies for integrated behavioral health programs, utilization management standardization, and cost-effective quality outcomes ... multi-state region. + Provides psychiatric leadership and clinical expertise for utilization management , case management , and integrated behavioral… more
- Adecco US, Inc. (Tallahassee, FL)
- …hire if compact) + APRN license accepted if current and compliant + Case Management , Nursing, or Utilization Review certification preferred **Benefits** + ... its Case Management team. This role focuses on care coordination, utilization management , patient throughput, and discharge planning across the continuum of… more
- The County of Los Angeles (Los Angeles, CA)
- …the following: + Additional experience in clinical nursing. + Supervisory** experience in Utilization Review and/or Case Management . SPECIAL REQUIREMENT ... the work of staff, and evaluating employee performance. For this examination, Utilization Review is defined as provides technical and administrative direction… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and 3-5 years in a managed care health plan setting. + Strong understanding of Utilization Review , Care Management and Medical Polices. + Knowledge of APR ... concerns Key Qualifications + Strong clinical skills and understanding of HMM's Utilization Management , Case Management and operational procedures, Medical… more
- Albany Medical Center (Albany, NY)
- …works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to ... assigned service - required + Recent experience in case management , utilization management and/or discharge...Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... range of medical/clinical knowledge. + Expertise in, or willing to learn utilization management , state/federal regulations, private payer contracts. + Dedication… more