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The Medical Director of LTSS is a member of the Medical Management Department of the Alameda Alliance for Health (“health plan”) and assists the Chief Medical Officer in developing and implementing clinical policy designed to meet the DHCS triple aim: improving the patient experience of care; improving the health of populations; and reducing the per capita cost of health care.
$267,700.47 - $401,550.72 a yearFull-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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Supervises utilization management personnel and oversee all utilization management functions, including inpatient admissions, concurrent review, prior authorization, and referrals to care management.
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Influences and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs. Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health) who will utilize their clinical skills to support the coordination, documentation, and communication of behavioral health services and/or benefit administration determinations.
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As a Utilization Management Coordinator, you report to the Supervisor of Utilization Management and partner closely with the Care Navigation & Intake teams. Contribute as an active and enthusiastic member of the UM team, and continually monitor, evaluate, and make recommendations for enhancements to the utilization management process.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, in both managed care and non-managed care environments. Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist with development and implementations of discharge plans.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Collects and analyzes performance reports on utilization management functions to monitor adherence with benchmarks, identify opportunities for process improvement, and develop recommendations to leadership.
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The Utilization Management Nurse collaborates as necessary with other members of the health care team to ensure the above according to the mission of CHRISTUS. The Utilization Management Nurse III is responsible for determining the clinical appropriateness of care provided to patients and ensuring proper hospital resource utilization of services.
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Oversees, monitors, orients and trains staff in the use of standard utilization management criteria including ASAM. Leads development of utilization management policies and procedures to ensure compliance with state and federal requirements and incorporate industry best practices.
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Resource/Utilization Management appropriateness: Assess assigned patient population for medical necessity, level of care, and appropriateness of setting and services. Utilize independent scope of practice to identify, evaluate, and provide utilization review services for patients and analyze information supplied by physicians (or other clinical staff) to make timely review determinations, based on appropriate criteria and standards.
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The Utilization Review Nurse will conduct medical necessity reviews in accordance with the Utilization Management Plan for patients that are on a nursing unit to include: Inpatient admissions, Observation and Outpatients in a Bed status.
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Serves as a liaison with headquarters, TRICARE regional offices, MTF staff and professional organizations concerning Utilization Management practices. Completes all required electronic medical record training, MTF-specific orientation and training programs, and any AF/DoD mandated Utilization Management training.
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Under the direction of Utilization Management (UM) leadership, the UM Coordinator processes prior authorization with established criteria. Under the direction of Utilization Management (UM) leadership, the UM Coordinator processes prior authorization with established criteria.
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Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
$29.1 - $62.31Full-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The Utilization Management Nurse 2 work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. Humana Healthy Horizons is seeking a Utilization Management Nurse 2 who utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations.
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The Utilization Management Nurse 2's work assignments are varied and frequently require interpretation and independent determination of the appropriate courses of action. The Utilization Management (UM) Nurse 2 uses clinical nursing skills to support the coordination, documentation, and communication of medical services and benefit administration determinations.
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Title: utilization management Company: Alameda Alliance For Health
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