- CHRISTUS Health (Wake Village, TX)
- …Advisor or CMO when discrepancies are present. * Performs the initial clinical medical necessity review utilizing evidence-based criteria and enters into ... management of patients in Observation status to include repeated review of clinical and opportunities for conversion...required. Experience Minimum of two (2) years' experience in Case Management and/or Utilization Management is required.… more
- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor sources. Identifies… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management, and ... **Overview** **The Utilization Review Physician collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization ** **Management & Clinical documentation.** **b. Oversight… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... **Overview** The Senior Utilization Review Specialist collaborates with the...direction and support regarding CMS & NJDOH regulations governing Utilization Management & Clinical documentation. b. Oversight… more
- Prime Healthcare (Ontario, CA)
- …or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health Plan + An ... strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with facility-based case … more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review / case management/ clinical /or combination; ... independently, prioritize effectively and have critical thinking skills. Experience in case management or care coordination and telephonic care experience is… more
- WellSpan Health (York, PA)
- …CM leadership team in developing and maintaining CM policy including, Utilization Review , Social Services and Clinical Case Management. + Identifies ... telephonic liaison staff) and the function of precert, concurrent review and denial management. + Acts as a resource...(BSN) Required Work Experience: + 2 years Experience in Case Management, Utilization Management, or clinical… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years utilization review / case management/ clinical /or combination; ... like in this role: Employee will be providing telephonic case management for our members. + Past job instability....nurses MUST have 4 years or more of RECENT clinical experience. + Strong communication skills required to provide… more
- Alight (NJ)
- …occupational health, worker compensation, disability, health case management, or utilization review . + 2+ years as a Clinical Case Manager + ... careers.alight.com (https://careers.alight.com/us/en) . **About the Role** This role will provide clinical expertise and serve as a critical link between all parties… more
- Trinity Health (Silver Spring, MD)
- …management/supervision/leadership experience in an acute healthcare setting required, preferably with case management, utilization review or closely related ... **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in...area. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + Knowledge… more
