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UTILIZATION CASE MANAGER

Monitors in-patient care and facilitates appropriate transition to out-patient or lower levels of care by referencing CHG-approved clinical criteria for utilization management decisions; reviewing members medical record; communica...

CompanyCommunity Health Group
AddressChula Vista, CA
CategoryInformation Technology
Salary$90K - $114K a year
Date Posted a month ago See detail

Utilization Case Manager

Community Health Group

Chula Vista, CA

$90K - $114K a year

Monitors in-patient care and facilitates appropriate transition to out-patient or lower levels of care by referencing CHG-approved clinical criteria for utilization management decisions; reviewing members medical record; communica...

a month ago seen See more...

Nurse Manager Utilization Management

Kaiser Permanente

South San Francisco, CA

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

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Utilization Review RN - Utilization Management Dept OCGMC

Kpc Global Medical Centers Inc.

Santa Ana, CA

$50 - $85 an hour

Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings Serves as on-going educator to all departments. Responsible for reviewing patient charts in...

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Utilization Review Specialist

Affinity Recovery

Newport Beach, CA

$65,000 - $75,000 a year

Clinical Record Review: Thoroughly review mental health and substance abuse clinical records. Utilization Determination: Evaluate treatment plans and services for compliance and necessity. Collaboration: Work closely with clinical...

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Utilization Review Nurse - Case Management

Kern Medical

Bakersfield, CA

$41.32 - $65.10 an hour

New Hire Bonus: $6,000.00. New Hire Premium: +6% of base rate of pay, matched up to 6% if contributed to Deferred Compensation Plan. Shift Differential Pay: 10% of base pay for hours worked from 7:00 PM to 7:30 AM, with two (2) ho...

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Nurse Manager Utilization Management - Newark, United States - Kaiser

Kaiser

United States

Manages the operations of 24-hour departments that may be at multiple locations. Ensures Assistants and staff provide the highest quality of care and are in compliance with the Nursing Practice Act, The Joint Commission, federal,...

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Supervisory Acquisition & Utilization Specialist

York State Department Of Labor

New York, NY

Responsibilities Duties: The Supervisory AcquisitionUtilization Specialist renders expert contract pre-award and post award expertise to all Administrative and Clinical Service lines within the VA Healthcare System (HCS) and supp...

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Utilization Review (UR) Specialist - Addiction Treatment Program

Renewal Health Group

Los Angeles, CA

Medical, dental, vision, short-term disability, and life insurance. Reimbursement for licensing fees. Education assistance. Employee referral bonus. Healthcare Flexible spending account with $250 company contribution for Full time...

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Physician Utilization Review Specialist

Hackensack Meridian Health

Hackensack, NJ

The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical records for the patient population and HackensackUMC. These includ...

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Care Manager RN – Utilization Review

Providence

Missoula, MT

$36.40 - $57.63 an hour

Graduate of an accredited school of nursing Or. Graduate of an accredited health information technology program. Upon hire: Montana Registered Nurse License. 3 years of experience in Clinical Nursing. Hospital case management expe...

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Utilization Review Specialist

Delta Specialty Hospital

Memphis, TN

$46.7K - $59.2K a year

Act as liaison between managed care organizations and the facility professional clinical staff. Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care organizations (MCOs) and coor...

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Utilization Review Specialist

Pacific Grove Hospital

Riverside, CA

$60.6K - $76.7K a year

Competitive Salary. Paid Time Off. Paid Holidays (8 Total). Medical, Dental, & Vision Insurance. FSA & HSA Plans. Long-Term & Short-Term Disability. Company Paid Life Insurance. Supplemental Life Insurance. Employee Assistance Pro...

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UTILIZATION REVIEW NURSE - CASE MANAGEMENT

North Oaks Health System

Hammond, LA

Physical Effort RequiredStrength: SedentaryPush: occasionallyPull: occasionallyCarry: occasionallyLift: occasionallySit: frequentlyStand: frequentlyWalk: frequentlyResponsibilities:Monitors and facilitates initial and continued st...

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UR (Utilization Review) Specialist

Sunshine Behavioral Health

Denver, CO

$58,000 - $60,000 a year

Conducts timely; Precertification, Concurrent and Discharge reviews (Peer reviews and eligibility checks as necessary) as well as retro reviews and appeals as needed. Organizes and communicates information necessary to complete da...

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Interim Nurse Manager, Utilization Review

Firstchoice

Fresno, CA

$4,300 a week

State of California Registered Nurse (RN) License. Current American Heart Association (AHA) BLS Certification. Minimum of 2 years of hospital URM supervisory/management experience. MCG or InterQual Certification, preferred. 401(k)...

2 months ago seen See more...

Utilization Review Specialist

Tuerk House

Baltimore, MD

$49.3K - $62.4K a year

Maintains documentation of clinical reviews in Utilization Management Portal (OPTUM). Sends thorough reviews to OPTUM and Private insurance as appropriate. Coordinates peer review and notifications, per policy. Collaborates with...

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Case Manager/Utilization Review

Saint Anthony Hospital

Chicago, IL

$70.9K - $89.7K a year

Bachelor's degree in healthcare or related field; BSN preferred. Licensed as a Registered Nurse in the State of Illinois. Five years recent clinical experience in a hospital setting, or four years recent clinical experience. Utili...

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Senior Associate, Information Specialist – Content Optimization & Utilization

Pfizer

Cambridge, MA

$78,000 - $130,000 a year

Support optimization of SIC licenses by monitoring/analyzing/reporting usage metrics/trends to enable learning opportunities and inform renewal decisions. Partner with R&D groups on select initiatives involving eResource and eCont...

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Utilization Review Case Manager - FT Days

Torrance Memorial Medical Center

Torrance, CA

$53.40 - $82.22 an hour

Tracks avoidable days....

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Utilization Review Specialist

Coastal Media Group

Boca Raton, FL

$55,000 - $75,000 a year

Ability to be aggressive in advocating on behalf of our facilities to insurance carries. Ability to communicate effectively with clinical team to understand treatment needs of patients. Understanding of their role in a multi-disci...

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Specialist - Utilization Review - Full Time, Days (Hollywood)

Prospect Medical Holdings

California, United States

From $23.20 an hour

Interfaces with all payors and providers requesting authorizations, medical records, and other specific information. Completes payor and provider request for missing or additional documentation. Logs all authorization requests to...

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Manager, Utilization Management (UM Oversight & Clinical Administration)

Caloptima

Orange, CA

Cultivates and promotes a mission-driven culture of high-quality performance, with a member focus on customer service, consistency, dignity and accountability. Directs and assists the team in carrying out department responsibiliti...

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Utilization Review RN Care Manager II

Professional Management Enterprises

Indianapolis, IN

Cold call outreach to members,. Completion of member multiple enrollment and follow-up assessments,. Creation of member care plans. Input documentation into multiple computer systems. Daily collaboration with CM/UM/Pharmacy peers...

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REMOTE UTILIZATION REVIEW CASE MANAGER

Carson Tahoe Health

Carson City, NV

Transition management Assigns appropriate length of stay, participates in readmission prevention, transition level of care and patient satisfaction. Utilization management Screens for accurate medical necessity using approved...

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Utilization Review Specialist

Department Of Behavioral Healt

Washington, DC

$89,958 - $115,104 a year

Criminal background check;. Traffic record check (as applicable);. Consumer credit check (as applicable);. Reasonable suspicion drug and alcohol test; and. Post-accident or incident drug and alcohol test....

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Case Management Nurse Utilization Review Inpatient: Remote

Florida Health Care Plans, Inc.

Florida, United States

$68.8K - $87.2K a year

Current licensure in Florida as a Registered Nurse. Minimum of 3 years clinical experience; acceptable areas include Ambulatory Care, Medical/Surgical, or ICU required. Previous experience with referrals, Case Management, pre-cert...

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Manager Utilization Management Remote

Adventhealth Corporate

Altamonte Springs, FL

$72.6K - $91.9K a year

Benefits from Day One. Career Development. Whole Person Wellbeing Resources. Mental Health Resources and Support. Evaluates the efficiency, clinical appropriateness, necessity of the use of medical services and procedures in the m...

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Manager of Utilization Review

Charlie Health

Remote

$79.9K - $101K a year

Interviewing, hiring, training and onboarding new teammates. Acting as a liaison between UR and other CH Departments (RCM, Clinical, Operations, Outreach/Admissions). Supporting the development, implementation, and evaluation of d...

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Utilization Review Specialist (Behavioral Health)

Canyon Ridge Hospital

Chino, CA

$22 - $28 an hour

Competitive Compensation Canyon Ridge Hospital provides a challenging and rewarding work environment. Growth and development opportunities within UHS and its subsidiaries Minimum Bachelors Level Degree in nursing, social work, ps...

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UTILIZATION REVIEW (UR) SPECIALIST - PART TIME

Stonington Institute

Groton, CT

$54.5K - $69K a year

Consult with Admissions Department regarding specific LOC issues, insurance requests, and/or criteria questions. Complete initial precertification for all levels of care. Knowledge of UR processes required for all payor sources i....

2 months ago seen See more...

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