- Sutter Health (Sacramento, CA)
- …8 years of recent relevant experience. * 2 years experience in Utilization Management ( UM ) and Clinical Denial Management Preferred **SKILLS AND KNOWLEDGE:** ... * Knowledge of ACMA, CMSA, and NASW Standards of Practice. * Knowledge of available health care and community resources * A broad knowledge base of health care delivery and case management within a managed care environment. * Comprehensive knowledge of laws,… more
- Catholic Health Services (Melville, NY)
- …Island's Top Workplace! Job Details Position Summary: The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals according to ... criteria guidelines. The UAM serves as interdepartmental liaison identifying denial reasons and opportunities for improvement from both internal and external… more
- AdventHealth (Tampa, FL)
- …Stroke Center. **The role you'll contribute:** Under general direction of the Manager of Utilization Management, supervises all functions of ensuring complete and ... issues identified at quarterly JOC meetings at discretion of Manager . Performs supervisory duties in the absence of the...team:** . Plans, develops, organizes, and supervises Auth / Denial Support staff in daily operations of working accounts,… more
- Whidbey General Hospital (Coupeville, WA)
- …review, status determination, clinical resource utilization, the discharge planning and appeal/ denial management. The RN - Care Manager serves as the ... JOB SUMMARY The RN - Care Manager is a health care professional with experience... will lead an assessment to identify the patient's clinical needs to be accommodated and constructs a care… more
- UCLA Health (Los Angeles, CA)
- …next level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management, you'll provide direct management to a team of ... UM coordinators and nurses. You'll work closely with Medicare...overseeing and coordinating the following major functions: + Pre-service Authorizations/ Denial Letters + Concurrent Review + Continuity of Care… more
- LA Care Health Plan (Los Angeles, CA)
- …interaction to develop and implement a successful discharge plan. Works with the UM Manager and Physician Advisor on case reviews for pre-service, concurrent, ... Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- Sanofi Group (Indianapolis, IN)
- …delays for patients like required Benefits Investigations (BI), Prior Authorization (PA), Denial Appeals, detailed Clinical Documentation, and Peer to Peer ... **Job Title:** Field Reimbursement Manager - Rare Blood Disorders, Patient Support Services, Midwest...procedures. + Ensure training is completed and demonstrate appropriate clinical knowledge of the respective products + Manage and… more
- US Tech Solutions (Canton, MA)
- … UM team and works under the general direction of the Precertification Team Manager or department Manager . The Clinical Reviewer is expected to ... possible extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that… more
- Dignity Health (Santa Maria, CA)
- …Licensure and Certifications** Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred **Pay Range** $46.89 - ... utilizing evidence-based guidelines and critical thinking. Collaborates with the Concurrent Denial RNs to determine the root cause of denials and implement… more
- Hackensack Meridian Health (Hackensack, NJ)
- …support in overall medical management effectiveness, benchmarked utilization and cost management ( UM ) goals clinical improvement objectives f. Interfaces with ... and resolution of activities that assure the integrity of clinical records for the patient population and Hackensack University...documentation iv. Target DRGs Reviews v. Use of case manager as a resource 4. Uses guidelines to evaluate… more