- Baptist Memorial (Memphis, TN)
- …and/or life situation. Performs other duties as assigned. Responsibilities + Utilization Review + Discharge planning + Readmission Reduction Participation ... the safe transition of patients throughout the continuum of care for appropriate utilization of resources, service...or MSN Training Minimum Required Preferred/Desired + Certified Case Manager Special Skills + . Minimum Required + Critical… more
- Commonwealth Care Alliance (Boston, MA)
- … Utilization Management Reviewer reports to the Utilization Management Manager . * Conducts timely clinical decision review for services requiring prior ... 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care ...is responsible for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization… more
- Beth Israel Lahey Health (Plymouth, MA)
- …+ Reviews admission data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge ... to review , evaluate, and appeal clinical denials related to the care provided to the hospitalized patient. + Conducts concurrent reviews to determine the… more
- Samaritan Daytop Village (Rhinebeck, NY)
- …goal of sustaining high quality care /service delivery to persons served, the Utilization Manager works to assist CASAC Counselors and supervisory staff as ... needed with assuring compliance with external and internal utilization review /quality and appropriateness requirements. What qualifications do you need: +… more
- Prime Healthcare (Anaheim, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/218947/case- manager utilization ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...skills. Preferred qualifications: 1. Minimum 5 years of acute care experience preferred.2. Certified Case Manager (CCM)… more
- Prime Healthcare (San Dimas, CA)
- …school Of Social Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing experience preferred. At least ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/214914/case- manager -%28rn%29 utilization… more
- Community Health Systems (Naples, FL)
- **Job Summary** Under the direction of the UR Director/ Manager the UR Nurse reviews all admissions for medical necessity, correct orders based on medical condition ... Medical Record + Works with healthcare providers to ensure complete and accurate condition and care of the patient + Serves as a resource to support the UR team in… more
- Access Dubuque (Dubuque, IA)
- …you! The Utilization Management Assistant answers first level calls in Utilization Review for member participants. They will evaluate certification requests ... will also triage the call to determine if a Utilization Review Nurse is needed to complete...Staffing Services Administrative Assistant Express Employment Professionals Assistant Store Manager Kwik Stop Kwik Stop Utilization Management… more
- Rochester Regional Health (Rochester, NY)
- …able to work independently with minimum direction. + Act as a resource for utilization review stakeholders and assists team members in clinical problem solving. ... standard UM sources for potential inpatient medical necessity denials. Review patient class in the event manager ,... REQUIRED QUALIFICATIONS: + 3 years of acute hospital care , Case Management and/or Utilization Management experience… more
- Actalent (Redlands, CA)
- …internal staff to ensure seamless care coordination. Essential Skills + Utilization review and management experience. + Familiarity with Medicare, MediCal, ... Job Title: Remote LVN Case Manager - Utilization Management Job Description...clinical advanced degree preferred. + 1+ year of managed care experience preferred. + 1+ year of inpatient experience… more