- US Tech Solutions (Columbia, SC)
- …A typical day would like in this role: Employee will be providing telephonic case management and utilization management for our members. The expectation is ... per month. + Strong communication skills required to provide telephonic case management to patients and to coordinate with team, providers, and patient… more
- Veterans Affairs, Veterans Health Administration (South Jordan, UT)
- …S/he possess intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... assumes responsibility for own professional growth. Advocate fiscal responsibility in the management of patient care through effective utilization of resources.… more
- Centene Corporation (Springfield, IL)
- …For:** + **Registered Nurse (RN) with active Illinois license** + **Experience in case management and/or utilization review ** + **Previous work in an ... **Are you a passionate RN with a strong background in case management or utilization management within an inpatient setting? Join our dedicated team… more
- MTC (Raymondville, TX)
- …Monitor all potential catastrophic illnesses. 9. Implement basic cost containment and utilization management for patient care and facility operations. 10. Comply ... (EAP)** + **Paid Time Off (PTO)** + **Paid Holidays** **Impact lives with Management & Training Corporation (MTC) at the El Valle Detention Facility in Raymondville,… more
- AdventHealth (La Grange, IL)
- …skills + Data analysis skills + Current working knowledge of discharge planning, utilization management , care management , performance improvement and managed ... Worker is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- MTC (Anson, TX)
- …+ Monitor all potential catastrophic illnesses. + Implement basic cost containment and utilization management for patient care and facility operations. + Comply ... + **Paid Time Off (PTO)** + **Paid Holidays** **Looking to impact lives? At Management & Training Corporation (MTC) Medical, our purpose is to help those in need.… more
- UNC Health Care (Chapel Hill, NC)
- …and supporting cost-effective discharge planning. + Serve as a key resource in case management , utilization review , and discharge planning. + Stay compliant ... 7. Payer Communication: a. Collaborate with payers, insurance companies, and utilization management teams to optimize reimbursement and facilitate timely… more
- MVP Health Care (Schenectady, NY)
- …every interaction **Your key responsibilities:** + Utilize the essentials of an integrated utilization management and case management model that includes ... accreditation standards (eg, NCQA), including documentation and reporting. + Cost Management : Monitor service utilization to maintain cost-effectiveness and… more
- CareFirst (Baltimore, MD)
- …Licensure. **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
- US Tech Solutions (Columbia, SC)
- …with Management + Skill sets: Appeals and reconsideration experience, Utilization management experience, Prior experience working for a health insurance ... established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency, claims knowledge/analysis, and… more
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