- VNS Health (Manhattan, NY)
- …or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state ... and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …improvement activities by identifying opportunities for improvement in such areas as clinical outcomes, utilization of resources and concurrent data collection; ... patient services/procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION… more
- Independent Health (Buffalo, NY)
- …perks, benefits and commitment to diversity and inclusion. **Overview** The Program Manager - Utilization Management (UM) will be accountable for the management, ... IH associates on the use and implementation of new criteria. + Monitor utilization trends and clinical appropriateness and make changes (add/remove) in services… more
- VNS Health (Manhattan, NY)
- …or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state ... and federal regulations. Delivers timely notification detailing clinical decisions. Coordinates with management, subject matter experts, physicians, member… more
- Stanford Health Care (Palo Alto, CA)
- …to delivering evidence-based and patient-centered care. We are seeking a results-driven manager to further develop the framework for clinical , operational, and ... Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation, partnerships,… more
- Veterans Affairs, Veterans Health Administration (Palo Alto, CA)
- …Former EDRP participants ineligible to apply. Responsibilities The RN - Utilization Management is focused on individual growth and development in practice ... Uses UM Criteria to perform basic reviews while developing technical and clinical competencies. The major duties and responsibilities include, but are not limited… more
- Veterans Affairs, Veterans Health Administration (Washington, DC)
- …practice, including access to care and discharge planning. Using advanced clinical knowledge judgment to promote staff involvement in planning, decision-making, and ... evaluating outcomes. Functioning as an expert in clinical practice and/or areas related to the assigned roles and responsibilities. Systematically evaluating current… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of Parkwest ... to end of approved number of authorized days, reviews clinical justification for continued stay and assigns further days,...Hospital to identify and address problems related to the utilization process and to monitor and track the resolution… more
- Behavioral Center of Michigan (Warren, MI)
- …to help educate the staff and physicians regarding charting. REPORTS TO: Utilization Review Lead/ Manager QUALIFICATIONS: + High School Diploma or equivalent. ... the level of nursing care and collaborates with other departments in evaluation of projects affecting discharge plans. Supports clinical improvement activities… more
- AdventHealth (Altamonte Springs, FL)
- …893 Hope Way Altamonte Springs, FL 32714 **The role you'll contribute:** The Clinical Resource Manager provides leadership and consultation to company facilities ... in the clinical review, evaluation and procurement of products...**The value you'll bring to the team:** + Facilitates clinical teams to review utilization and options… more