benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... which promote quality, cost-effective outcomes by helping member populations achieve effective utilization of healthcare services...
requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis... Director, Case Manager, Preventive Services, Subrogation, Quality of Care Referrals, etc.). Participates in data collection...
TITLE: Director Case Management / Utilization Management / CDI Location: Buckeye Lake, OH Now is your chance... while simultaneously promoting cost-effective resource utilization. Provides director-level oversight of Inpatient and ED Case Management...
Required: At least 5 years of varied RN clinical experience in an acute hospital setting. At least 2 years of Utilization Management/Case...) requirements for Utilization Management or Care Management (CM). Knowledge of Department of Health Care Services (DHCS...
Anticipated End Date: 2025-12-25 Position Title: Utilization Management Representative... I Job Description: Utilization Management Representative I Location: This role enables associates to work virtually full-time, with the exception...
Job Description: Supervisor, Utilization Management Manager I – BPM Who We Are: UST HealthProof is a trusted... reaches all, equitably and effectively. You Are: The Supervisor, Utilization Management is responsible for management...
We are recruiting for a Utilization Management Coordinator (UMC) to join an established healthcare organization... School Diploma or GED is required. AA degree in related field is preferred. 2+ years utilization management coordination...
The Medical Director, Utilization Management, provides organizational leadership in the operational areas of appeals... Director(s), Utilization Management, and the Vice President, Medical Affairs. The following responsibilities are regarding...
Manager, is responsible for the hospital-wide Utilization Management Programs in a general acute care hospital which serves...Job Category: Revenue_Cycle Job Description: Under broad direction from the Centralized Utilization Management...
Management/Utilization Management Review the treatment plan and advocate for additional services as indicated. Promote..., program manager, nurse manager, and various members of the team. Collaborate with the treatment team regarding continued...
Management/Utilization Management Review the treatment plan and advocate for additional services as indicated. Promote..., program manager, nurse manager, and various members of the team. Collaborate with the treatment team regarding continued...
GENERAL SUMMARY: Reports to the Manager of Pharmacy Benefits and other delegated pharmacist. Facilitates the operations... of the Pharmacy Care Management Department by organizing, improving, and implementing pharmacy benefit management policies...
outcomes, and promote health equity. Position Responsibilities: Specific Design utilization management programs... and outpatient utilization management programs to ensure cost-effective use of patient care resources case delivery at the...
as a leader of positive change. The Care Management, Care Coordinator, Utilization Management is a member of the healthcare team... for a designated patient caseload; the Care Coordinator, Utilization Management plans effectively in order to manage length of stay...
: Utilization Management services supporting medical necessity and denial prevention Coordinating with payors to authorize... days Other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management Balances clinical...
Director of Case Management / Utilization Management / CDI Location: near Gratiot, OH Now is your chance..., Utilization Management, and Clinical Documentation Integrity (CDI). Lead a team of 50–60 Case Managers, UM staff, and CDI...
is looking for a Utilization Management Reviewer to monitor the utilization of clinical services provided at Mental Health Resource Center (MHRC... and external providers. Investigates complaints, grievances, and medication variances. Reports findings to Utilization Management...
The Utilization Management (UM) RN performs utilization review activities, including, but not limited... in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified...