2504 utilization review case management rn jobs found

Responsibilities Focuses on leadership in the multidisciplinary planning and coordination of the patient’s care across the healthcare continuum. Organizes the sequence of patient care to attain maximum levels of effectiveness and efficiency to reach desire quality, clinical, and cost outcomes. Organizes multiple strategies to ensure the case of all patients is managed with minimal overlapping roles and processes. Participates in a team approach composed of the physician, social work, providers (direct and indirect) community resources, and payers.   Conducts medically necessary utilization, manages home/outpatient services and in collaboration with the clinical team and medical provider, provides discharge planning coordination and intervention. Strives to promote patient wellness, improve care outcomes, efficient utilization of health services and minimize denials of payment among a patient population with complex health needs.   Communicates and updates leadership...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Description JOB SUMMARY Responsible for managing overall Care Management department operations including staffing, budgeting, planning, and regulatory compliance. Directly supervises CM Representatives, Utilization Management RNs, and provides coordination with the Care Managers that are unit based. The Manager CM recommends priorities and provides management for functions of utilization review, including but not limited to medical necessity, authorization, concurrent denials, and post-discharge denials. Works in collaboration with the unit-based Care Managers and their manager to provide critical utilization management during the patient stay including the issuance of hospital-issued denial notices, condition code 44, and QIO requests. He/she helps support the Director to assure consistent practice and outcomes involving appropriate level of care, resource utilization, associated revenue cycle activities, safe patient discharge, care transitions, and readmission prevention. The...

Sign-on Bonus and Relocation Reimbursement available Receive 17% weekday nights, 26% weekend nights, or 15% weekend day shift differentials Join our Amazing team at the University of New Mexico Hospital as a Care Manager We are seeking passionate individuals who will work in collaboration with clinical teams to achieve quality outcomes for patients within our local communities. As a day shift, full-time, Care Manager and Discharge Planner, you would be working for the only Level I Trauma hospital within Albuquerque, NM. OVERVIEW As team member you would monitor and coordinate the patient plan of care to ensure continuity throughout all health care settings. · Conduct timely discharge planning by anticipating patient needs · Effectively utilize tools and resources when developing a comprehensive multidisciplinary plan of care · Drive change by identifying areas of performance improvement to improve the delivery of quality patient care We invite you to join us in this vital role and...