- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will work ... families throughout the continuum of care. The RN Case Manager assists patients in the utilization of appropriate health care services. Position may require … more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care by assuring compliance with policies, including safety, ... **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages policies… more
- Prime Healthcare (Ontario, CA)
- …school of nursing and a current state Registered Nurse license. + Minimum 3 years RN Utilization Manager working for a Health Plan. + At least 3 years of ... experience in utilization review, referrals, authorizations, denials and appeals. + Current BCLS (AHA) certificate upon hire and maintain current. + Knowledge of MCG… more
- AdventHealth (Tampa, FL)
- …The Utilization Management RN Supervisor reports directly to the Divisional Utilization Management RN Manager and assists in monitoring and performing the ... is responsible for the daily administrative tasks as assigned by the Utilization Management RN Manager . The Supervisor will serve as the primary point of contact… more
- Commonwealth Care Alliance (Boston, MA)
- …& Responsibilities: * The Utilization Management Reviewer reports to the Utilization Management Manager . * Conducts timely clinical decision review for ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA)...accurate documentation of clinical decisions and works with UM Manager to ensure consistency in applying policy * Works… more
- Ascension Health (Baltimore, MD)
- …Manage activities, workflow and resources of assigned nursing travelers. + Ensure compliance with regulatory and accreditation requirements for their assigned team. + ... **Details** + up to $5,062 gross full weekly travel rate + **Department:** Ascension Travel Program & Interim Leadership + **Schedule:** Full-time + **Hospital:** St. Agnes + **Location:** Baltimore, MD * Rates may vary by location and specialty. Stipends… more
- Beth Israel Lahey Health (Burlington, MA)
- …a job, you're making a difference in people's lives.** Manages the Utilization Management (UM) team, maintaining effective and efficient processes for determining ... with the Physician Advisors, Collaborates and helps facilitate the Utilization Review Committee. Continuously monitors processes for opportunities for improvement… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient statusing ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization ... 1. Minimum 5 years of acute care experience preferred.2. Certified Case Manager (CCM) certification preferred.3. At least one-year experience in case management,… more
- Actalent (Olympia, WA)
- …case management and care coordination. + Experience with EPIC software. + Utilization review and appeals handling capabilities. + Discharge planning and population ... health management. Additional Skills & Qualifications + Basic Life Support (BLS) certification. Work Environment We have different types of shifts available such as 4x10s, 5x8s and 3x12s. 4x10 and 5x8 shifts are Monday-Friday from 7 am - 5:30 pm. The 3x12… more