Utilization Manager Jobs in Pasadena (TX)

The components/roles of the inpatient case management program consist of the following: Care Facilitation, UtilizationManagement, Case Management and Discharge Planning.

The Director is responsible for developing systems and processes for care/utilization...

and accurate information to payors. The role integrates and coordinates resource utilizationmanagement, care facilitation, and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement...

utilizationmanagement, care facilitation and discharge planning functions. In addition, the Case Manager helps drive change by identifying areas where performance improvement is needed (e.g., day to day workflow, education, process improvements, patient...

of the case management program at the local level. The components/roles of the inpatient case management program consist of the following: Care Facilitation, UtilizationManagement, Case Management and Discharge Planning.

The Director is responsible...

in the state of Texas or

• Current and valid license as a Master Social Worker (LMSW) in the state of Texas required, LCSW preferred
• Case Manager Certification required

Experience / Knowledge / Skills:

• Three (3) years experience in utilizationmanagement...

of utilizationmanagement processes preferred.

License/Certification:

RN is Highly preferred with or without a Bachelor's degree, LPN - Licensed Practical Nurse - State Licensure required. Performs medical necessity and clinical reviews of authorization...

A leading healthcare company is seeking a Care Review Clinician for a 6+ month contract role.

Summary:

Works with the UtilizationManagement team primarily responsible for inpatient medical necessity/utilization review and other utilization...

• Actively contributes...

/ Skills:

• Three (3) years experience in utilizationmanagement, case management, discharge planning or other cost/quality management program.
• Minimum three (3) years of experience in hospital-based nursing or social work.
• Excellent interpersonal...

The Medical Directors activities primarily focus on the application of clinical knowledge in various utilizationmanagement activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package...