- Humana (Jackson, MS)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- UCLA Health (Los Angeles, CA)
- …+ experience in an HMO environment + Thorough knowledge of health care industry, utilization review , utilization management, and concurrent review ... all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of UM coordinators and… more
- Hartford HealthCare (Willimantic, CT)
- …clinical nursing required. * Two years experience with case management, discharge planning, utilization review and/or home care required. * Knowledge of the ... Works under the direction of the Manager of Continuing Care and Utilization Management and in collaboration with physicians, social services, and other hospital… more
- Liberty Healthcare Corporation (Salisbury, MD)
- …are living with developmental disabilities + Service coordination + Case management + Utilization review + Prior authorizations + Claims reviews + Healthcare ... this initiative, Liberty is now hiring for a full-time Utilization Reviewer position. As a Utilization Reviewer,...a full-time Utilization Reviewer position. As a Utilization Reviewer, your daily work will involve: + Conducting… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patients receive… more
- Sanford Health (Rapid City, SD)
- …Full time **Weekly Hours:** 40.00 **Department Details** Join our team as a Utilization Review and Case Management Manager and lead a high-impact, data-driven ... while optimizing value across the care continuum. You'll shape and execute utilization strategies that become the standard for how we coordinate care, authorize… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Nurse (APN) or Physician Assistant (PA) for the Transition Utilzation Review Team utilizes a patient-centered coordinated care model, demonstrating competencies in ... leadership, direct clinical practice, consultation/collaboration, coaching/guiding, research, and ethical decision-making. The APN or PA works collaboratively with the practice/hospital team to assess, plan, and implement care for individuals with health and… more
- Highmark Health (Bismarck, ND)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards… more