- Evergreen Health (Jamestown, NY)
- Evergreen Health The Telephonic Care Coordinator applies the essential activities of case management which include assessment, planning, coordination, monitoring and ... Services) to patients within the Center for Care Coordination. The Telephonic Care Coordinator provides care coordination for patients with a diagnosis… more
- UPMC (Pittsburgh, PA)
- …home? UPMC Health Plan is looking for you! We are hiring a full-time Telephonic Care Manager to join the Home and Community-Based Services (HCBS) Command Team. The ... will predominantly work standard daylight hours, Monday through Friday. The Telephonic Care Manager is responsible for care coordination and health education… more
- Elevance Health (Atlanta, GA)
- ** Telephonic Nurse Case Manager I - $3000 Sign-On Bonus Offered** **Location: This is a virtual position, but you must reside in the State of Georgia.** **Work ... the assessment within 48 hours of receipt and meet the criteria._** The ** Telephonic Nurse Case Manager I** is responsible for telephonic care management… more
- Universal Health Services (Groton, CT)
- …DC, Puerto Rico and the United Kingdom. www.uhs.com Job Summary: The Utilization Review Specialist is responsible for the pre-certification, concurrent, and ... Department Head and Billing of any denials and complete telephonic or written appeals when necessary. + Liaison between...or related Human Service Field or RN. Knowledge of Utilization Review Processes, insurance plans, mental health… more
- LA Care Health Plan (Los Angeles, CA)
- …referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and ... Utilization Management Nurse Specialist LVN II Job Category:... review or input and presents for physician review if indicated. Perform telephonic and/or on… more
- LA Care Health Plan (Los Angeles, CA)
- …referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review , and ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or on site admission and concurrent review… more
- State of Michigan (Lansing, MI)
- …1-2 years + Less than 1 year + None 07 This position is a telephonic prior authorization review process, do you have any professional nursing experience working ... Medicaid Utilization Analyst 9-P11 - BPHASA Medical Equipment and...and Inclusion Plan. This position functions as a clinical review professional responsible for conducting clinical reviews of applications/requests… more
- Universal Health Services (Conway, SC)
- …Job Posting Lighthouse Behavioral Health Hospital is hiring for a Part Time RN Utilization Review Coordinator. Utilization Review / Risk Management ... UHS and its 300+ Subsidiaries! Flexible Schedule Qualifications Job Requirements The Utilization Review Coordinator position will consist of Four 8-hour Daylight… more
- CVS Health (Raleigh, NC)
- …a keyboard and speaking to customers. Preferred Qualifications: - 1+ years' experience Utilization Review experience -1+ years' experience Managed Care - Strong ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote...telephonic communication skills -Ability to exercise independent and sound… more
- CVS Health (Raleigh, NC)
- …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications - 1+ years' experience Utilization Review experience - 1+ years' experience Managed Care - ... make health care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote...Strong telephonic communication skills - Experience with computers toggling between… more
- Humana (Tallahassee, FL)
- **Become a part of our caring community and help us put health first** Utilization Management Nurse -Front End Review utilizes clinical nursing skills to support ... EST (must reside in Florida) Available to work 2 Holiday a year. The Utilization Management Nurse 2 Front End Review uses clinical knowledge, communication… more
- Spokane County (Spokane, WA)
- …Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. Note: Three (3) professional ... and discharges or lack of movement toward discharge. + Collaborates with Utilization Review Integrated Care Coordinator regarding continued inpatient stay… more
- Elevance Health (Cerritos, CA)
- …required by managers. **Shift:** **M-F; 8:30am-5:00pm** Responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH ... cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues....of care for inpatient/outpatient + BH services; ensures appropriate utilization of BH services through level of care determination,… more
- Commonwealth Care Alliance (Springfield, MA)
- …accepted medical guidelines, and appropriate scope of practice. + Provide regularly scheduled telephonic calls to support the management of chronic disease or end of ... with understanding their CCA Health Benefit package. + Perform annual comprehensive telephonic assessments and coordinate any needed follow up from results. +… more
- Kepro (Chicago, IL)
- …Supervising and managing the day-to-day activities of the assigned case management and utilization review teams. + Mentoring, coaching, and training team members ... Supervises, mentors, coaches, trains, and develops the: o Case review and utilization review teams...(CCM). + Analytical, reporting, and data management skills. + Telephonic case management and/or triage experience. + Knowledge of… more
- CVS Health (Salt Lake City, UT)
- …service Preferred Qualifications - Crisis intervention skills preferred - Managed care/ utilization review experience preferred- Case management and discharge ... planning experience preferred Discharge planning experience - Utilization review , prior authorization, concurrent review , appeals experience - CCM preferred… more
- Highmark Health (Dover, DE)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Albany Medical Center (Albany, NY)
- …the RN may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's specific care plan ... or APP and documents results in EHR * Performs review and triage of incoming test results, patient requests...and follow-up; patient and parent education * Facilitates the utilization of resources to meet patient outcomes and contribute… more
- CVS Health (Lansing, MI)
- …to 10% of the time for face to face visits.This role is a telephonic clinical case management position working with our Medicaid population. Use of Motivational ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes.Assessment of… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
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