- 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
- Molina Healthcare (Rio Rancho, NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- Catholic Health Services (Roslyn, NY)
- …with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource ... Overview Director-Care Management Are you exceedingly driven, dedicated, and passionate...and appropriate documentation. Competencies + Priority Setting + Time Management + Action Oriented + Composure + Informing +… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a ... description of position** : A Medical Principal performs medical review and case management activities. The physician...will serve as a clinical educator and consultant to utilization management , case management , network,… more
- Carle Health (Normal, IL)
- …utilization issues in appropriate locations, including but not limited to: case management / utilization review software and the multidisciplinary plan of ... Overview Responsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring hospitalization for… more
- Evolent (Springfield, IL)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... work with a group of nurses, providing appeal intake review for one dedicated client. They interact with coordinators...Be Doing:** + Practices and maintains the principles of utilization management and appeals management … more
- Houston Methodist (Houston, TX)
- …state, local and federal programs + Progressive knowledge of discharge planning, utilization management , case management , performance improvement and managed ... is a registered nurse (RN) responsible for comprehensively planning for case management , which includes care transitions and discharge planning of a targeted patient… more
- HCA Healthcare (Sanford, FL)
- …in Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Lone Tree, CO)
- … Department operations, functions and staff in alignment with the annual Utilization Management Program Description as well as applicable regulations and ... the guidance and supervision of the Director of Case Management (CM), the CM Manager is responsible and accountable...and family needs with the efficacious and cost effective utilization of resources. The CM Manager shares responsibility for… more
- CommonSpirit Health (Salt Lake City, UT)
- …Leaders at the assigned sites. This position provides support to the facility Utilization Management Committees, medical staff, UM Hub, and care coordination ... manage/prevent denials, manage length of stay, meet licensure, compliance, quality and utilization management requirements to ensure optimal patient outcomes and… more