- UNC Health Care (Smithfield, NC)
- …care and cost effectiveness through the integrating and functions of case management, utilization review and discharge planning. The Care Manager must be highly ... policies. Responsibilities: 1. Identify Cases & Prioritize Day - Review work list to prioritize patients and identify new...from CAPP as appropriate. As necessary meet with the Utilization Manager (UM) and SW after the meeting to… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... most clinically appropriate care to patients while promoting the most cost-effective utilization of the hospital's resources. The Director Case Mgmt Social Svcs… more
- Evolent (Lansing, MI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Radiology you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Evolent (Madison, WI)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Management, you will be a key member of the utilization management team. We can offer you a meaningful...the regulatory timeframe of the request. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Baylor Scott & White Health (Temple, TX)
- …coordinating patient care across the continuum to include case management, social work, utilization review and care coordination to achieve optimal clinical and ... problem solving related to care coordination, discharge planning, case management and utilization review . Monitors processes and systems to ensure efficient… more
- Evolent (Helena, MT)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Oncology, you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. . Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Community Health Systems (Naples, FL)
- …for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and transitions of care. The role ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the medical ... for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical effectiveness… more
- Ventura County (Ventura, CA)
- …The ideal candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of ... and review ; + Performs daily clinical reviews to support utilization and quality management, ensuring compliance with guidelines and standards for patients… more
- CVS Health (Phoenix, AZ)
- …+ Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes + ... meaningful difference in the lives of patients? Join Mercy Care as a Utilization Management Clinical Consultant and become part of a mission-driven team that's… more