- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted patient population on a designated unit(s) and/or service… more
- Trinity Health (Fresno, CA)
- **Employment Type:** Part time **Shift:** **Description:** This position coordinates utilization review service for defined patient populations across the acute ... care continuum. This includes discharge planning, utilization management , care coordination collaboration, and support for resource utilization . This… more
- Highmark Health (Concord, NH)
- …Highmark Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of ... and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent with established… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point of contact… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a ... description of position** : A Medical Principal performs medical review and case management activities. The physician...will serve as a clinical educator and consultant to utilization management , case management , network,… more
- Bon Secours Mercy Health (Toledo, OH)
- …medical education, electronic health records, and clinical research. Support of quality management , utilization management , risk management , infection ... senior leadership team. Provides leadership and advisement in quality, case management , clinical research and clinical IT structures. Physician executive leadership… more
- Providence (Olympia, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... National Certification in area of specialty. + 1 year experience in care management or utilization review in any setting or successful completion of TIPS… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …regulatory requirements, and ensures these requirements are accurately followed and Utilization Management (UM) decision determinations and timeliness standards ... registered nurse (REQUIRED) + Three (3) years of clinical experience (REQUIRED) + Utilization Management experience + Experience working in the health plan… more
- Covenant Health (Lubbock, TX)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... in Nursing within 3 years of hire. + 1 year of experience in care management or utilization review in any setting or successful completion of TIPS program or… more
- Providence (Anchorage, AK)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... Certification in area of specialty + 1 year of experience in care management or utilization review in any setting or successful completion of TIPS program… more