- 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
- Molina Healthcare (Rio Rancho, NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... 3-5 years clinical practice with managed care, hospital nursing or utilization management experience. **Preferred License, Certification, Association** Active,… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... policies and procedures to determine clinical appropriateness. * Completes review of both medical documentation and claims data to...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Bakersfield Behavioral Healthcare Hospital (Bakersfield, CA)
- …risk management , infection control, environmental safety, quality control, and utilization review ; strong oral and written communication skills, current ... About Us Bakersfield Behavioral Healthcare Hospital, located in Bakersfield, California, is...communication skills. Job Summary Leads the Quality and Risk Management Team through Process Improvement initiatives at the hospital.… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... in behavioral health clinical practice, provider relations, or healthcare management Desired Experience (nice to have): * Experience working with managed care… more
- Commonwealth of Pennsylvania (PA)
- …calls, personal visits, and review of treatment progress reports; conduct utilization review . Orient clients to the program, policies, procedures, and ... Drug & Alcohol Case Management Specialist (Local Government) - Delaware County D&A...clients or discharge planning via telephone, personal visits, or review of treatment progress reports; conducting utilization … more
- Elevance Health (Wilmington, NC)
- …and overseeing assigned care managers and ensuring fidelity to the CFSP Care Management model which includes physical health, behavioral health, and social ... **Manager Care Management , Foster Care (Manager I GBD Special Programs)**...the same basic benefits and services, including Physical health, Behavioral health, Pharmacy,_ _Intellectual/Developmental_ _Disabilities (I/DD) services, long term… more
- Sevita (Detroit, MI)
- …states to increase census, maintain occupancy, improve daily attendance, and maximize utilization . + Financial Management : + Oversee billing to ensure accuracy ... infants, children, adolescents, Military Service Members and Veterans. **Operations Management Executive Director - State of MI** **Compensation: $140,000-$160,000/year… more
- Molina Healthcare (Sparks, NV)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... attitude for success **Preferred License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). RN licensure preferred… more
- Prime Healthcare (Chula Vista, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... In addition to our healthcare services, we offer comprehensive behavioral health services on the hospital campus and Bayview...the coordination of the various activities of the Case Management Department under the direction of the assigned Case… more