- Swedish Health Services (Seattle, WA)
- …Manager RN @ Swedish First Hill** **Part time 0.5 FTE** **Day Shift** The nurse case manager coordinates the care and service of selected patient populations through ... and external to the organization, to improve patient care through effective utilization and monitoring of healthcare resources and assumes a leadership role to… more
- Mount Sinai Health System (New York, NY)
- …+ Experience Requirements + Previous experience as in homecare, long term care or utilization review preferred. + Discharge Planner or Case Manager preferred. + ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective...Essential Duties: + Collaborate and set standards with registered nurse (RN) case managers (CMs) and outcome managers to… more
- University of Utah Health (Salt Lake City, UT)
- …+ Negotiates with third party payers relative to benefit levels, eligibility, utilization review , and reimbursement. + Identifies actual and potential delays ... outpatient settings. Coordinates care and resources with physicians, social workers , and other team members to achieve optimal patient...following** + **Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more
- Alameda Health System (Oakland, CA)
- …contracted vendors. + Responsible for the coordination and support of the AHS Utilization Review Committee. + Responsible for overseeing patient, physician and ... manages the collection, analysis and presentation data relevant to the utilization of healthcare resources, including but not limited to avoidable/variance days,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Case Manager (CM) Certified position is a registered nurse (RN) responsible for comprehensively planning for case management of a targeted ... treatment outcomes. The CM Certified position holds joint accountability with social workers for discharge planning and continuity of care and assures that admission… more
- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Provides direction and assistance to Care Coordinators and to Community Health Workers (CHW) of members needs including the need for special educational mailings,… more
- Veterans Affairs, Veterans Health Administration (Grand Junction, CO)
- …direct supervision of the REACH-VET Coordinator, who is an advanced practicing licensed social worker , and the REACH VET Nurse Case Manager, who is a registered ... determined by the VHA Education Loan Repayment Services program office after review of the EDRP application. Former EDRP participants ineligible to apply.… more
- Brighton Health Plan Solutions, LLC (Westbury, NY)
- About The Role MagnaCare provides Utilization Review / Case Management/ Medical Management/Claims Review services to its clients. Care Coordinators facilitate ... care management and utilization review by performing data collection &...data collection & data entry, and effectively communicating with Nurse Case Reviewers/Managers, employers and claimants in regard to… more
- CenterWell (North Charleston, SC)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. + Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more