- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Quality Reporting and Auditing Specialist I Job Category: Clinical Department: Utilization Management Location: Los ... required to achieve that purpose. Job Summary The Utilization Management (UM) Quality Reporting and Auditing Specialist I is responsible for dynamically… more
- UNC Health Care (Morrisville, NC)
- …the unique communities we serve. **Summary** : The **Executive System Director of Utilization Management (UM)** is a strategic and operational leader responsible ... for designing, implementing, and standardizing utilization management functions across a large healthcare...management . + Advanced skills in data analysis and reporting and strategic planning. + Experience in clinical system… more
- George C. Grape Community Hospital (Hamburg, IA)
- …years of clinical nursing experience (acute care preferred). o Prior experience in utilization review, case management , quality improvement, and infection ... Quality / Utilization Review Nurse Position Summary: The...& Collaboration: o Educate clinical staff on documentation requirements, utilization management processes, and infection control standards.… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management services supporting medical necessity and denial prevention ... potentially avoidable days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical and financial requirements and… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …journey optimization covering: onboarding, network management , utilization management interaction, claims processing, quality reporting , and ... and technology domains. **What You'll Lead** **Strategic Initiative Portfolio Management ** + Own end-to-end execution of 5-8 enterprise transformation initiatives… more
- McLaren Health Care (Port Huron, MI)
- …hospital **Preferred:** ⦁ Experience in utilization management /case management , critical care, clinical documentation, or patient outcomes/ quality ... as Assigned:** 1. Performs a variety of concurrent and retrospective utilization management -related reviews and functions to ensure that appropriate… more
- Intermountain Health (Las Vegas, NV)
- …including social work and complex care planning, transitions of care, and utilization management . The position ensures compliance with state, national, and ... + Demonstrated care management experience. + Authorization or Utilization Management experience. + Leadership experience. **Preferred Qualifications** +… more
- Beth Israel Lahey Health (Plymouth, MA)
- …Management Certification required + Minimum of 3 years of progressive experience in utilization management and appeal/denial management . + Holds a strong ... a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager -...proud to be a trusted healthcare provider, offering personalized, high- quality care to the South Shore of Massachusetts. As… more
- Minnesota Visiting Nurse Agency (Minneapolis, MN)
- …of or ability to learn financial management related to UR function and reporting , quality improvement processes, and human resources management * Able to ... review functions. Oversees daily operations, which include supervising staff performing utilization management activities. The goal is to achieve clinical,… more
- Huron Consulting Group (Chicago, IL)
- …Management and works with hospital leadership to coordinate and integrate utilization management activities, using continuous quality improvement ... and reporting to verify outcomes, effectiveness of utilization management activities and appropriate use of...stay and level of care, while promoting cost-effective and quality patient care. Position is located in Annapolis, MD… more