- UPMC (Pittsburgh, PA)
- …for behavioral health services. The Utilization Management (UM) Care Manager is responsible for utilization review of health plan services ... Health Plan is hiring a full-time Behavioral Health UM Care Manager to support our UM Clinical...information obtained from interaction with members and providers. + Review and document clinical information from health care… more
- Wellpath (Franklin, TN)
- …make a difference** The Regional Care Manager (RCM) is responsible for utilization review , care coordination, and daily care management across ... or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management and pre-certification experience + Knowledge… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- *_SUMMARY:_* We are currently seeking a* Utilization Review Manager * to join ourTransitional Care Team.This is a full-time role and will be required to ... reimbursement requirements. Serves as a resource to the health care team for utilization and denial management....required or completed within three years of hire **Title:** * Manager - Utilization Review * **Location:**… more
- UNC Health Care (Smithfield, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who ... and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager...care determination and the appeal/denial process. + Oversees utilization review workflow processes to ensure timely… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- UNC Health Care (Raleigh, NC)
- …through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....with medical terminology and in criteria for acute psychiatric care or combination of education and experience preferred. +… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical necessity and level of ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Prime Healthcare (Lynwood, CA)
- …Connect With Us! (https://careers-primehealthcare.icims.com/jobs/228577/rn-case- manager utilization - ... to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,...Work for Licensed Clinical Social Worker. However, RN Case Manager preferred.3. Five years acute care nursing… more
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