- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge,… more
- Humana (Jefferson City, MO)
- …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
- Catholic Health Initiatives (Lisbon, ND)
- …+ 3-5 year's current clinical experience in acute care settings + Prior Case Management / Utilization Review **Where You'll Work** CHI Lisbon Health is a ... **Job Summary and Responsibilities** As a Case Management Professional, you will be a pivotal coordinator...planning team. + Documents discharge planning as an ongoing review . + Monitors and coordinates swing bed referrals. +… more
- CareFirst (Baltimore, MD)
- …Appeals and Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Fairview Health Services (Minneapolis, MN)
- …knowledge of utilization review and collaborates with the Utilization Management Specialists to insure the ongoing, comprehensive monitoring and ... in the treatment planning process. + Coordinates treatment planning and leads management of each case. + Coordinates/facilitates the development of treatment plan by… more
- University of Washington (Seattle, WA)
- …the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management ), ... communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- Healthfirst (NY)
- …oversight and operational management for all utilization management functions, including prior authorization, concurrent review , and service requests ... efforts for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional… more
- Elevance Health (Ashburn, VA)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. Please be ... necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
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