- Veterans Affairs, Veterans Health Administration (St. Louis, MO)
- …slot management . Improve access metrics and reduce missed opportunities. Review utilization data and report trends to Surgical Service leadership. ... in accordance with VHA policy and state licensure requirements. Act as Physician Utilization Management Advisor (PUMA) for the Department of Surgery: Monitor and… more
- Molina Healthcare (NM)
- …with multidisciplinary teams to promote Molina care model. * Adheres to utilization management (UM) policies and procedures. * May work collaboratively ... attitude for success **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). RN licensure preferred… more
- Dignity Health (Long Beach, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Dignity Health (Los Angeles, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Health Care Service Corporation (Albuquerque, NM)
- …practice in state of operations + 3 years clinical experience, including 2 years utilization review or case management experience + Quality improvement ... Professional Health Care Quality (CPHQ Certification) + NCQA/CMS Auditing experience + Utilization Management background + Knowledge of Millman Care Guidelines… more
- Houston Methodist (The Woodlands, 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
- Dignity Health (Long Beach, CA)
- …emphasis will be on care coordination communication and collaboration with utilization management nursing physicians ancillary departments insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Centene Corporation (Lansing, MI)
- …analysis, and/or ROI evaluation preferred. Familiarity with claims payment, utilization management , provider/vendor contracts, risk adjustment for government ... large amounts of data across multiple system platforms and sources + Review data to determine operational impacts and needed actions; elevate issues, trends,… more
- CommonSpirit Health Mountain Region (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
- Dignity Health (Glendale, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more