- Dartmouth Health (Keene, NH)
- …of research-based critical pathways and outcome measurement preferred. Experience in case management , utilization review and discharge planning preferred. ... physician practice, while emphasizing care coordination across the continuum. Perform utilization management activities as necessary to ensure that medical… more
- BJC HealthCare (Alton, IL)
- …cancer care, rehabilitation, 24-hour emergency care, ambulance services and more. Case Management , Utilization Review , Social Services: Provides admission ... to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to… more
- Prime Healthcare (Joliet, IL)
- …Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring that ... patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of.... + Collaborate with healthcare teams to facilitate effective utilization management . + Employ MCG criteria and… more
- Evolent (Lansing, MI)
- …the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care across the… more
- Catholic Health Initiatives (Lexington, KY)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** **Required...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- RiseBoro Homecare Inc. (Brooklyn, NY)
- …cost-control goals. Technology, Training, and Reporting . Oversee implementation and utilization of facilities management technology systems, including Yardi, ... ESSENTIAL DUTIES AND RESPONSIBILITIES The Director of Facilities Management provides strategic leadership and oversight of the operations, maintenance, and capital… more
- CareFirst (Baltimore, MD)
- …experience. **Experience:** 3 years Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient ... This role will assist leadership with the development and review of Care Management standards, program criteria, policies, and procedures to ensure quality… more
- Stanford Health Care (Palo Alto, CA)
- …initiatives and guidance for product evaluation teams. + Train Value Based Management committee members to analyze and review data effectively during ... trends within health care and academic medical centers that may impact product/service utilization or Value Based Management processes. + Collaborate with key… more
- BD (Becton, Dickinson and Company) (Franklin Lakes, NJ)
- …planning, charter development, project timelines, budgets, resource allocation, risk management , and conducting Industrialization Gate Review System reviews. ... and Metrics:** Define and track benchmarks for program delivery, resource utilization , and risk management ; provide executive-level reporting and insights… more