of Utilization Management (UM) RN is responsible for executing the day-to-day operations of the UM department, and monitoring the... Interdisciplinary Care Team. Recommends resources to improve performance standards in terms of Utilization Management. Collaborates...
comprehensive utilization management and coordination of care for SRS Members. Ensure timely and appropriate processing of managed... -REQUIRED Preferred Qualifications 3 Years experience as an LVN in a hospital or clinical setting. 2 Years utilization/Case Management...
About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs... to meet required turnaround times. Prepares and presents cases to Medical Director (MD) for medical director oversight...
direction of the Manager, Care Management and Medical Director. Interacts in a professional manner with providers, patients... Experience 2+ years of experience in utilization management in the health plan or medical group environment Experience...
Inpatient Utilization Management Clinician is responsible for evaluating all inpatient medical treatments for medical necessity..., and collaborating with care management and medical directors to support members in achieving optimal health outcomes. Our Investment...
) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests... between acute care facilities. Acts as a department resource for medical service requests/referral management and processes...
Role Overview: The After Hours Behavioral Health (BH) Utilization Management (UM) Reviewer is scheduled to work non... members with appropriate specialized behavioral health care coordination and care management services by completing medical...
or skilled nursing facility position involving clinical care, quality management, utilization and case management, or medical... leadership to obtain necessary approvals of new strategies for utilization management. Knowledge of current medical literature...
will apply medical health benefit policy and medical management guidelines to authorize services and appropriately identify and refer... requests to the Medical Director when guidelines are unmet. The Reviewer will maintain current knowledge and understanding...
(2) years acute care nursing experience. One (1) year acute case management or utilization management experience... preferred. Utilization management experience is preferred. In Lieu Of Employees in this title prior to 1/26/2025...
of Utilization Management is a key member of the healthcare organization’s leadership team and is charged with meeting the... will be an expert on matters regarding physician practice patterns, over and under-utilization of resources, medical necessity, levels...
:00pm) Remote Yes Category Executive Responsibilities The System Vice President of Utilization Management is a key... physician practice patterns, over and under-utilization of resources, medical necessity, levels of care, care progression...
precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. Review... of two (2) years of prior experience in Utilization Management. Must possess a current, active, full, and unrestricted...
, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal processes. Provides staff education..., reporting them promptly to the Process Improvement/Quality Director, to appropriate clinicians and to the UM Manager. Reviews...
Responsibilities In collaboration with the manager/director of Performance Improvement, the coordinator..., directions and be able to follow-through. Good communication skills both verbal and written. Experience with Medical Staff...
We are recruiting for a motivated RN Registered Nurse, Utilization Coordinator Denver Health Medical Plan - Remote... utilization review activities to determine the efficiency, effectiveness and quality of medical and behavioral health services...
management, utilization review, performance improvement, infection prevention, risk management, or accreditation... with our patients and teammates. Job Summary The Director of Quality Assurance/UR/PI is responsible for strategic leadership...
of care support. How you make a difference The Medical Director of Utilization Management leads and oversees utilization... utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners...
orientated medical chart reviews and other administrative tasks to meet the requirements of the medical center's utilization... of case management or utilization management experience. Knowledge of InterQual or McKesson criteria preferred. Knowledge...
cost and efficient use of medically appropriate services. Integrates and coordinates utilization management activities... transfers from UTMB TDCJ Hospital to specialty services hospitals. ESSENTIAL JOB FUNCTIONS: Utilization Management...