the Centralized Utilization Review department and collaborates with staff across the Southern California Region. Duties... to submit required documents. Retrieves and delivers messages from Utilization Review Dept phone review line at least 4 times...
in performance improvement, utilization review, or case management. CERTIFICATIONS, LICENSES OR REGISTRATION REQUIRED: Valid RN... license. CPUM (certified professional in utilization management), ACM (accredited case manager), or CCM (certified case...
Job Category: Registered Nurse Job Description: Job Overview: This position may perform utilization management... on denied claims, pre-pay and post pay audit review. This staff works independently with a high level of autonomy and decision...
Duties and Responsibilities: Performs inpatient utilization management activities as determined by the utilization... clinical experience preferred. Previous utilization management experience preferred. Knowledge of Medicare/Medicaid...
Job Category: Associate Job Description: Wealth Management Across Wealth Management, Goldman Sachs helps empower... clients and customers around the world to reach their financial goals. Our advisor-led wealth management businesses provide...
, strategy, and execution for Utilization Management (UM) and Pharmacy across all lines of business, ensuring alignment... through medical review and prior authorization, behavioral health management, clinical intake, and inpatient and outpatient...
progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management. 16..., teach and collaborate with others. Excellent critical thinking skills related to nursing utilization review Knowledge...
Knowledge of workers' compensation claims process Prospective, concurrent and retrospective utilization review PAY RANGE...Description : The Professional Review Specialist analyzes medical services and billing across various claim types...
Knowledge of workers' compensation claims process Prospective, concurrent and retrospective utilization review PAY RANGE...Description : The Professional Review Specialist analyzes medical services and billing across various claim types...
to effectively promote all Professional Review products with attorneys, claims examiners, customers and management Strong ability... areas of O.R., I.C.U., C.C.U., E.R., and orthopedics preferred Prospective, concurrent and retrospective utilization review...
in Southern California by Integrated Healthcare Associates (IHA). The Senior Manager, Post Acute Care Management is responsible... for the overall management of Care Management services for Cedars-Sinai Medical Network. The Senior Manager researches...
Anticipated End Date: 2026-02-01 Position Title: Licensed Manager I Care Management (Guilford Co) CFSP... as required by law. The Manager I Care Management (Manager I GBD Special Programs) is responsible for managing and overseeing assigned...
MaxHealth is seeking a strong Manager of Outpatient Care Management will provide strategic and operational leadership... and development of population health tools and care management programs that optimizes quality of care, clinical outcomes, utilization...
hospital's Care Management program, including Utilization Review (UR), care coordination, discharge planning, and payer medical... in Utilization Review, Case Management, or Care Coordination Knowledge of CMS Conditions of Participation and Medicare regulations...
Anticipated End Date: 2026-02-14 Position Title: Manager of Behavioral Health - Indiana SMI Case Management... is required for this role. The Manager of Behavioral Health – Indiana SMI Case Management is responsible for overseeing a team of clinicians...
The Events Management Manager oversees the coordination of logistics for meetings and events in the firm's Client..., while maintaining global standards. This manager will collaborate with partners in Technology as well as the broader Regional Management...
position: Nurse Manager - Case Management. Nurses with experience in any of the following areas are strongly encouraged..., Utilization Review, or VP. Shift(s) available: day shift, night shift, and mid shift Job types available: full time, part time...
Job Category: Events Management Job Description: The Events Management Manager oversees the coordination... excellence are essential. As an Events Management Manager, you will lead the seamless coordination of meetings and events...
with strong care management, utilization review, and payer knowledge. A Case Management certification or obtaining a Case Management.... The Acute Case Manager has the responsibility, accountability, and authority for coordinating the medical management...
of Health Patient Review Instrument (PRI) Assessor. 3 - 5 years Discharge planning and/or utilization management. Knowledge... to join our team as a Care Manager (RN) **Hospital Care Management Experience Preferred**. In this role, the successful candidate...