- CareFirst (Baltimore, MD)
- …week. **ESSENTIAL FUNCTIONS:** + Trains staff on standards of practice of Utilization Management and reimbursement methodologies and treatment coding. + Manages ... in standard medical practices and insurance benefit structures. + Proficient in utilization management processes, standards, and managed care. + Knowledge of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …cases to the Medical Director for review. Refer to and work closely with Case Management to address member needs. Participates in rotating on-call schedule, as ... depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of… more
- Humana (Frankfort, KY)
- …Qualifications** + Bachelor's degree in nursing (BSN) + Previous experience in discharge planning, utilization management or case management a plus + ... a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Tallahassee, FL)
- …a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 + Clinical knowledge, communication… more
- CVS Health (Oklahoma City, OK)
- …+ 5+ years of clinical practice experience in behavioral healthcare + 2+ years utilization management experience is required + 2+ years of experience with ... **Position Summary** The Manager, UM Clinical Services, conducts oversight and management of clinical team processes including the organization and development of… more
- Florida Health Care Plans, Inc. (Daytona Beach, FL)
- … within the community to various locations. POSITION SUMMARY: As part of the Utilization Management division, the social worker will intervene with members who ... order to fully engage with members and their families, travel to hospitals, rehab or skilled nursing facilities and...relationships with FHCP colleagues and external vendors in providing case management services is essential to the… more
- Guthrie (Sayre, PA)
- …clinical approaches and make recommendations for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the ... , utilization review, and payer knowledge. A Case Management certification or obtaining a ...as necessary in the performance of this position. + Travel for this position is sometimes required. + Participation… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.).… more
- Amergis (French Camp, CA)
- …+ Current RN licensure in state practicing + At least one year of Case Management experience preferred + Current CPR if applicable + TB questionnaire, ... **Local Pay $75/hr** - No stipend pay The RN Case Manager is responsible for coordinatingcontinuum of care activities...week RNs will be doing denials, discharge planning, and utilization review Hiring points for a perfect candidate: Current… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Director Case Management & Social Services RN position is responsible for strategy, function and operations of the Case ... entity committees as a voice for the department. + Sets direction for Case Management /Social Services which supports strategic and operational plans, and overall… more
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