- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... care standards for appropriate utilization of services. Perform utilization management / review for medical necessity for specialty referrals and… more
- Alameda Health System (San Leandro, CA)
- …identified fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in a professional ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA...(Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their specialization ... In addition, they will support clinical programs (disease and case management ), as well as the review and adoption of health plan developed review criteria.… more
- ERP International (Luke AFB, AZ)
- … Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management with social work… more
- BeOne Medicines (San Mateo, CA)
- …Resource Management will lead the end-to-end global budget & resource management / utilization within GCO including the development of the Annual Operating ... team on resource-related decisions, including prioritization, hiring, and FSP vendor utilization . + Lead cross-functional resource review forums to optimize… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy ... and diagnosis codes for company medical policies and UM ( Utilization Management ) guidelines that reflect medical necessity, experimental/investigational… more
- Campbell County Health (Gillette, WY)
- …focuses on integrating care management , social services, discharge planning, utilization review and post-hospital services to ensure clinical efficacy and ... Promotes empowerment of resident in self- management of disease process. * Utilization review of the resident stay is done in a timely manner and is… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
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