- UCLA Health (Santa Monica, CA)
- …of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital ... License and BLS certification + Recent experience in case management , utilization management and discharge...Knowledge of a large university teaching hospitals Preferred: Strong Utilization Review experience and understanding of CMS… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status research, etc.… more
- Ochsner Health (Slidell, LA)
- …operative, and postoperative data components for the Program through the effective utilization of the hospital medical record systems. + Responsible for the accurate ... Medical Records, and Information Systems Departments whose support is necessary for the management and success of the Program. + Adapts behavior to the specific… more
- CVS Health (Hartford, CT)
- …Automation Team supports the implementation of strategic initiatives for the Utilization Management (UM) Clinical Services organization. These initiatives ... other healthcare integration standards + Healthcare industry experience, especially in Utilization Management or clinical operations. + Familiarity with clinical… more
- 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
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Northwell Health (Melville, NY)
- …as needed. + Inpatient clinical experience; 4+ years preferred. + Prior Acute Case Management and/or Utilization Review experience, preferred. + Must have ... level of care decisions and billing status and ensures compliance with the Utilization Review standard and regulations. + Performs concurrent and retrospective … more
- Trinity Health (Muskegon, MI)
- …to learn regulatory and accrediting agency standards and regulations relative to utilization management . Knowledge of federal, state and local regulations ... and patients and families. + Leadership qualities including time management , verbal and written communication skills, listening skills, problem...affecting the utilization review program and payment as well… 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
- 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