- Molina Healthcare (North Las Vegas, NV)
- …(ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At… more
- Providence (Spokane, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... National Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS… more
- Providence (Olympia, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... in area of specialty upon hire. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS program… more
- Providence (Olympia, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... National Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS… more
- Dignity Health (Northridge, CA)
- …written, and presentation skills to effectively collaborate with diverse stakeholders. + Utilization Management & Case Management : Understanding of how ... utilization management and case management programs integrate to optimize patient care. + Teamwork...Skills: Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Customer Service:… more
- Lakeview NeuroRehabilitation Center (Waterford, WI)
- …3 years broad clinical experience, predominately in a medical-surgical setting. Case Management , discharge planning, and utilization review experience ... plan for the patient. + Has overall accountability for care coordination, utilization management , and discharge planning for patients within the assigned… more
- Henry Ford Health System (Detroit, MI)
- …+ Proficiency with computers, electronic health records (EHR), database systems, and utilization review /case management documentation systems. + Knowledge of ... resources to optimize patient outcomes and promote efficient resource utilization . Key Responsibilities: Clinical Care Coordination: + Conduct comprehensive patient… more
- Penn Medicine (Plainsboro, NJ)
- …to all relevant parties, including but not limited to patient, family, Utilization Reviewer , and outpatient treatment providers. + 3. Provides specialized ... coverage on weekends as scheduled. + 8. To provide coverage for utilization management as needed or directed. Credentials: Education or Equivalent Experience: +… more
- Katmai (Fort Carson, CO)
- …providers and ancillary healthcare workers. + Apply principles of utilization review (UR) and utilization management (UM) in processing specialty ... + Review collected data to identify areas requiring intensive management . Analyze data collected and prepare reports describing resource utilization … more
- LA Care Health Plan (Los Angeles, CA)
- …adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert ... can include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management , Medical Directors, and other internal teams to… more