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Acts as a resource to the medical staff, administrative staff, divisional, SCPMG, TPMG and external regulatory agencies in all issues relating to utilization management within the Service Area or Medical Center.
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Ensure closed loop communication with IEHP Utilization Manager (UM) sending information on newly identified patient needs. This includes escalating care to ECM, Registered Nurse Care Management (RNCM) or the primary care practitioner (PCP) if vitals are outside of normal range.
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Responsible for direct management and utilization of laboratory (analytical and microbiology), water treatment, syrup blending, sanitation, microbiological equipment, raw materials, and all quality processes.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Director of Utilization Management for Moreno Valley Hospital, South Riverside County and Coachella Valley affiliate hospitals. May also be responsible for other integrated functions such as Discharge Planning, Case Management program, Outside Utilization Review program, Transportation coordination and Extended Care Coordination to promote a centralized, coordinated, interdisciplinary process in the continuum of care.
$148,800 - $192,500 a yearExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Become involved and participate in daily operational tasks including planning of freight; asset utilization; safety management; Department of Transportation (DOT) compliance; driver payroll; Customer Value Delivery; logistics management/analysis; driver supervision; profit-and-loss management; maintenance coordination.
InternExpandApply NowActive JobUpdated 17 days ago - UpvoteDownvoteShare Job
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Evaluate the quality of nursing or integrated care operations; keep informed of the condition of patients' and of unusual treatments, medications, or occurrences; make nursing evaluation rounds; receive reports of patients' admissions, discharges, and transfers; ensure enhanced discharge planning and integrated care management; analyze and report significant utilization trends, patterns and impacts to departments and medical staff committees.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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As a part of the Utilization Management team the Utilization Review RN is a member of the Care Coordination team. Utilization review, prior authorization, Care management, Case management, interqual, ncqa, ncqa standards.
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Education and Experience: Minimum five years of managed care experience either with a medical group or a managed care organization, with three years focused in utilization management, health plan criteria and benefit interpretation, authorization determination, and all aspects of health plan UM audits required.
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Minimum three years experience with a medical group, managed care organization, utilization management, hospital admitting, or medical nursing unit required. The Case Management Assistant (CMA) collaborates with Case Managers and Social Workers in assisting with the continuum of care and discharge planning.
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3 years of hospital-based Case Management experience including Utilization Review and Discharge Planning experience. The DCM is a patient and family advocate to ensure that services are delivered to meet the needs of patients and their families, and that the utilization of resources is appropriate.
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Four-year Bachelor’s Degree in Engineering, Chemistry, or related technical field with a minimum of 5 years’ chemical plant management experience or a minimum of 8 years’ experience in one or more chemical plant management functions: production, materials management, technical, engineering or maintenance.
Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Certification as a CCM, CIRS, or other Case Management certifications are preferred. A cost containment background, such as utilization review or managed care is helpful. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Provides Medical Case Management to individuals through in person and telephonic communications with the patient, physician, other health care providers, employer and others.
$29.97 - $45.34 an hourFull-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Job Description As a case management nurse (RN CM), you will collaborate with the healthcare team to assess, plan, facilitate and coordinate care for individual patients. Working within and outside of facilities, you will oversee the effective utilization of services and resources.
Full-timeExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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In collaboration with the Medical Director may identify needs for and participates in the development and implementation of Care Management/Utilization Management policies and procedures to promote cost-effectiveness quality medical care.
$165,900 - $214,616 a yearExpandUpdated 3 days ago - UpvoteDownvoteShare Job
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Educate providers on utilization and medical management processes. 3 years of experience in Prior Authorization/Utilization Review. Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care.
Full-timeRemoteExpandUpdated 18 days ago
utilization management jobs in Redlands, CA
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