- US Tech Solutions (Columbia, SC)
- …Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates ... education with members and providers regarding health care delivery system, utilization on networks and benefit plans. Serves as member advocate through… more
- CenterWell (Austin, TX)
- …Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to work ... ) required or completed within three years of hire **Title:** * Manager - Utilization Review* **Location:** *MN-Minneapolis-Downtown Campus* **Requisition ID:**… more
- UNC Health Care (Raleigh, NC)
- …care episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management ... needs are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in… more
- UNC Health Care (Hendersonville, NC)
- …the health and well-being of the unique communities we serve. Summary: The Utilization Manager (UM) assesses new admissions, continued stay and discharge review ... met and care delivery is coordinated. The UM completes utilization reviews in accordance with federal regulations and the...patient data and treatments. Communicates daily with the Care Manager to manage level of care transitions & appropriate… more
- Intermountain Health (Las Vegas, NV)
- …Monday-Friday 8:00 - 5:30 pm Holiday and weekend coverage when needed. The Manager of Care Management I leads and collaborates with care management operations across ... utilization review, acute and emergency department care, and ambulatory/community...national, and regulatory requirements while fostering workforce development. The manager plays a crucial role in shaping enterprise-wide strategies… 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
- Highmark Health (Harrisburg, PA)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care ... services, application of criteria to ensure appropriate resource utilization , identification of opportunities for referral to a Health Coach/case management, and… more
- Baystate Health (Springfield, MA)
- …Case Manager / Utilization Management** The **RN Hospital Case Manager ** is a registered nurse responsible for the coordination of clinical care, ... of a designated population of patients. The Hospital Case Manager is responsible for overseeing an efficient plan that...for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case- manager utilization ... post-graduation of an accredited school of nursing and a current state Registered Nurse license.2. Grandfathered prior to April 1, 2015. Minimum 5 years post… more