- 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
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... behaviors to internal leadership for assistance in resolution *Responsibilities:* * Review all inpatient admission and observation cases using InterQual, or Milliman… 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
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …+ Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of ... health + Experience in a managed care, case management, or utilization review setting + Strong understanding of behavioral health diagnoses, treatments, and… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …and administering activities related to clinical review , discharge planning, resource utilization , and utilization review . Your primary goal will be ... commitment to teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations + Ability to work autonomously… more
- HCA Healthcare (Kissimmee, FL)
- …and improve the patient flow program effectiveness as it relates to utilization review , resource management, and discharge planning and care coordination. ... the educational leader to physicians and employees as it relates to utilization review , resource management, patient flow, multi-disciplinary rounds and hospital… more