, preferably in Case Management and/or Utilization Management. Specialized Training: Trained in Epic, InterQual, Midas..., and resource/utilization management. The position requires excellent communication, clinical skills, and professional rapport...
of care to lower/higher levels of care, makes referrals for care management programs, and performs medical necessity reviews..., and retrospective review) for medical necessity referring to Medical Director as needed for additional expertise and review. Utilize...
UM Medical Director and/or the Director of Medical Management. Ensure network provider steerage and happening on OON network... and operational leadership to the day to day function of the Utilization Management Team. The UM Nurse Manager will ensure that the...
under the supervision of the Manager/Director and is responsible for working in collaboration with the healthcare team... to coordinate the care and service to patients across the continuum of care. The care manager promotes effective utilization...
team, Director of Utilization Management, and the Medical Director. Review charts at identified review points and attend... as a leader of positive change. The Utilization Management Coordinator utilizes clinical knowledge and understanding...
and referring requests for services to the Medical Director when guidelines are not met and reviewing residential services requiring... management and/or utilization review experience Associate degree required; bachelor's Degree preferred. Strong problem-solving...
with PACE Assistant Medical Director, with the Interdisciplinary Team (IDT) attending daily IDT meetings, with the Compliance... Director to monitor utilization patterns in line with quality indicators to optimize referral authorizations. Works...
Job Category: Revenue Cycle Management Degree Level: Bachelor's Degree Job Description: Position Summary The... Utilization Review Specialist is responsible for managing and coordinating the utilization review process for inpatient...
each and every day. Job Description: The Utilization Review RN performs activities which support the Utilization Management... functions. They are responsible for the delivery of the Utilization Management process including but not limited to: making...
patient needs from admission through discharge. Under the general supervision of the Director of Case Management, develops... medical record reviews. Makes utilization decisions based on established criteria. Collaborates and Communicates with case...
patient needs from admission through discharge. Under the general supervision of the Director of Case Management, develops... medical record reviews. Makes utilization decisions based on established criteria. Collaborates and Communicates with case...
principles of utilization management and serves as a consultant for issues regarding regulations, compliance, payor specific... criteria and the denial management process for the DCH System. Responsibilities: * Supervises utilization review professional...
Kingdom. www.uhs.com The UM Supervisor oversees the utilization management of the Behavioral Health Center including... UM goals and collaboration with the CBO as needed. This position oversees the Utilization Management Coordinator. The...
Kingdom. www.uhs.com The UM Supervisor oversees the utilization management of the Behavioral Health Center including... UM goals and collaboration with the CBO as needed. This position oversees the Utilization Management Coordinator. The...
: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Completes Utilization... actions to achieve continuous improvement in both areas. Refers cases and issues to Medical Director and Triad Team...
and referring requests for services to the Medical Director when guidelines are not met and reviewing residential services requiring... management and/or utilization review experience Associate degree required; bachelor's Degree preferred. Strong problem-solving...
: $71,612.39 - $110,999.20 Responsible for Utilization Management, Quality Screening and Delay Management for assigned patients. Completes Utilization... actions to achieve continuous improvement in both areas. Refers cases and issues to Medical Director and Triad Team...
Job Description: Responsibilities Willow Springs Center is looking for an experienced Utilization Management... work that you do, Willow Springs Center is the place for you. Position Overview The Utilization Management Manager...
Job Description: Responsibilities Willow Springs Center is looking for an experienced Utilization Management... work that you do, Willow Springs Center is the place for you. Position Overview The Utilization Management Manager...
RN Utilization Management Nurse – Frontline Opportunity Greater Orlando, Florida The RN Utilization Management Nurse..., and appropriate level of care. The Utilization Management RN leverages the algorithmic logic of the platform, utilizing key clinical...