- 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:** ... team to ensure cost effective utilization of departme * Facilitates complex clinical and financial decision making in conjunction with senior leadership by… more
- Point32Health (MA)
- …to leverage non- clinical resources on team, provides quarterly audits of the non- clinical denial letter team * Use professional and clinical judgment ... works under the general direction of the Inpatient Team Manager or department Manager . **Key** **Responsibilities/Duties** **-...clinical nursing experience. * Minimum 3 years of UM experience, preferably in an inpatient setting or managed… 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
- LA Care Health Plan (Los Angeles, CA)
- …and status follow-up. The Authorization Technician II collects information required by clinical staff to render decisions, assists the Manager and Director ... Authorization Technician II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time Requisition ID:… 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
- LA Care Health Plan (Los Angeles, CA)
- …regarding performance, customer service, etc. This position collects information required by clinical staff to render decisions, assists the Manager and Director ... Supervisor, Authorization Technician Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full Time… more
- LifePoint Health (Hickory, NC)
- Job Summary Manager of Case Management in the departments activities and resources to achieve departmental and organizational objectives and will take the lead in ... outcome of care management as described in the initial UM plan with regard to resources, appropriateness of care...DCM and business of denials and enters on a denial log. 12. Fights denials by not accepting if… 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
- Guthrie (Sayre, PA)
- … Manager -of Case Management supports utilization management, discharge planning, denial prevention, and care coordination scope of practice within the department. ... utilizing current practice and process to achieve optimal patient, clinical , and operational outcomes in timely, coordinated, and cost-...The Manager -Case Management collaborates cooperatively with members of the interdisciplinary… more
- LA Care Health Plan (Los Angeles, CA)
- …Management Admissions Liaison RN II (After Hours Evening) Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... net required to achieve that purpose. Job Summary The Utilization Management ( UM ) Admissions Liaison RN II is primarily responsible for receiving/reviewing admission… more