• VP, Phco Utilization Management Medicaid…

    Centene Corporation (Jefferson City, MO)
    …28 million members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various ... the operations of utilization management, reconciliation coordination, concurrent review ( telephonic and on-site), specialty therapy programs and other… more
    Centene Corporation (05/04/25)
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  • Telephonic Behavioral Health Caseworker

    AmeriHealth Caritas (Columbia, SC)
    …services. Discover more about us at www.amerihealthcaritas.com. **Responsibilities:** The Telephonic Behavioral Health Case Worker is responsible for managing and ... issues, gaps in care, and barriers to care. The Telephonic Behavioral Health Case Worker develops a plan of...care, referrals, and evaluation of the plan's effectiveness.; 2. Review the medication list and help members coordinate pharmacy… more
    AmeriHealth Caritas (05/01/25)
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  • Telephonic Nurse Case Manager I

    Elevance Health (GA)
    ** Telephonic Nurse Case Manager I** **Location: Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager I** is responsible for telephonic care management… more
    Elevance Health (05/01/25)
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  • Utilization Management Nurse Specialist RN…

    LA Care Health Plan (Los Angeles, CA)
    …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
    LA Care Health Plan (03/27/25)
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  • Utilization Management Services Rep…

    Excellus BlueCross BlueShield (Rochester, NY)
    …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.… more
    Excellus BlueCross BlueShield (04/27/25)
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  • Acute Care Nurse, HCT (RN)

    ChenMed (New Orleans, LA)
    …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provides telephonic or outpatient visits to patients at high-risk for...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
    ChenMed (02/22/25)
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  • Physician Advisor

    CommonSpirit Health (Houston, TX)
    …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more
    CommonSpirit Health (04/30/25)
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  • Acute Care Nurse, HCT (RN)

    ChenMed (Norfolk, VA)
    …healthcare setting experience is preferred. + Minimum of two (2) years of utilization review , case management, home health and/or discharge planning experience ... Responsibilities Include but are not limited to: + Provide telephonic or outpatient visits to patients at high risk...patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with… more
    ChenMed (05/02/25)
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  • Community Care Nurse, HCT (RN)

    ChenMed (Houston, TX)
    …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management, home health, discharge planning experience ... engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family… more
    ChenMed (03/28/25)
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  • Acute Care Nurse, HCT (Registered Nurse)

    ChenMed (Lakeland, FL)
    …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provide telephonic or outpatient visits to patients at high risk...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
    ChenMed (04/15/25)
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