GU · On-site
Support case management through data entry, case file organization, and document review. * Collaborate on special projects, such as workshops or community outreach. * Contribute to ongoing advocacy ...
Quick apply
GU · On-site
Support case management through data entry, case file organization, and document review. * Collaborate on special projects, such as workshops or community outreach. * Contribute to ongoing advocacy ...
Support case management through data entry, case file organization, and document review. * Collaborate on special projects, such as workshops or community outreach. * Contribute to ongoing advocacy ...
Quick apply
Support case management through data entry, case file organization, and document review. * Collaborate on special projects, such as workshops or community outreach. * Contribute to ongoing advocacy ...
Senior Project Manager - Marine Construction
Tamuning, GU · On-site
$104K - $142K/yr
Review project proposal or plan to determine time frame, funding limitations, procedures for ... Lead and develop marine equipment utilization and execution plans * Manage multiple marine handling ...
Senior Project Manager - Marine Construction
Tamuning, GU · On-site
$104K - $142K/yr
Review project proposal or plan to determine time frame, funding limitations, procedures for ... Lead and develop marine equipment utilization and execution plans * Manage multiple marine handling ...
$104K - $142K/yr
Review project proposal or plan to determine time frame, funding limitations, procedures for ... Lead and develop marine equipment utilization and execution plans * Manage multiple marine handling ...
Quick apply
Review Behavioral Health questionnaires. * Work with military providers on case-managed patients. Requirements * Active Clinical Social Worker license or Master Social Worker license in the state
Review Behavioral Health questionnaires. * Work with military providers on case-managed patients. Requirements * Active Clinical Social Worker license or Master Social Worker license in the state
Review Behavioral Health questionnaires. * Work with military providers on case-managed patients. Requirements: * Active Clinical Social Worker license or Master Social Worker license in the state
Quick apply
Review Behavioral Health questionnaires. * Work with military providers on case-managed patients. Requirements: * Active Clinical Social Worker license or Master Social Worker license in the state
Clinician (C&Y) (50091)
Hagatna, GU · On-site
$18 - $21/hr
Provide brief case management to coordinate referrals and connect clients with appropriate internal ... Collaborate with multidisciplinary team members to review assessment findings and coordinate ...
Clinician (C&Y) (50091)
Hagatna, GU · On-site
$18 - $21/hr
Provide brief case management to coordinate referrals and connect clients with appropriate internal ... Collaborate with multidisciplinary team members to review assessment findings and coordinate ...
Asset Protection Specialist
Tamuning, GU · On-site
$17.50 - $19/hr
... reviewing CCTV and exception reports, monitoring the store's physical security, auditing the ... Other responsibilities include: preparing accurate and detailed case reports documenting your ...
Asset Protection Specialist
Tamuning, GU · On-site
$17.50 - $19/hr
... reviewing CCTV and exception reports, monitoring the store's physical security, auditing the ... Other responsibilities include: preparing accurate and detailed case reports documenting your ...
$42.25 - $54.25/hr
Job Summary: Reports directly to the Home Health/Hospice Manager and responsible for providing ... Initiates Plan of Care when nursing services are not involved with the case and makes revisions if ...
$42.25 - $54.25/hr
Job Summary: Reports directly to the Home Health/Hospice Manager and responsible for providing ... Initiates Plan of Care when nursing services are not involved with the case and makes revisions if ...
Utilization Review Case Manager information
What are some common challenges utilization review case managers face when coordinating care across multiple departments?
Utilization Review Case Managers often navigate complex communication between physicians, nursing staff, insurance providers, and patients to ensure appropriate care and resource use. Balancing timely authorizations with evolving patient needs and varying documentation standards can be challenging. Additionally, staying current with changing regulations and payer requirements requires ongoing learning and adaptability. Building strong collaborative relationships and maintaining clear, concise documentation are key strategies for overcoming these hurdles.
What is a utilization review case manager?
A Utilization Review Case Manager is a healthcare professional responsible for evaluating the necessity, appropriateness, and efficiency of medical treatments and services provided to patients. They review clinical information, coordinate with providers and insurance companies, and ensure that patient care aligns with established guidelines and policies. Their goal is to optimize patient outcomes while managing healthcare costs and ensuring compliance with regulations.
What is the difference between Utilization Review Case Manager vs Utilization Review Nurse?
| Aspect | Utilization Review Case Manager | Utilization Review Nurse |
|---|---|---|
| Credentials | Typically requires a nursing license or relevant healthcare certification | Registered Nurse (RN) license is required |
| Work Environment | Office-based, insurance companies, healthcare organizations | Hospital, clinic, insurance review departments |
| Primary Focus | Reviewing medical necessity, coordinating care, managing cases | Assessing medical records, clinical review, patient care evaluation |
Both roles involve healthcare review and require nursing credentials, but the Utilization Review Case Manager often focuses on coordinating care and managing cases, while the Utilization Review Nurse emphasizes clinical assessment and review of medical records. Understanding these differences helps in choosing the right career path or job search focus.
What are the key skills and qualifications needed to thrive as a utilization review case manager, and why are they important?
To thrive as a Utilization Review Case Manager, you need a clinical background such as an RN or LCSW license, strong knowledge of medical necessity criteria, and experience with case management. Familiarity with utilization management software, electronic health records (EHRs), and knowledge of regulatory guidelines like Medicare and Medicaid are essential. Excellent communication, critical thinking, and negotiation skills help facilitate collaboration between patients, providers, and payers. These skills ensure appropriate resource use, compliance with regulations, and high-quality patient care.
What are popular job titles related to Utilization Review Case Manager jobs in Guam? For Utilization Review Case Manager jobs in Guam, the most frequently searched job titles are:
Other
Re-posted 12 days ago
Job description
Salary: unpaid
Position Overview:
We are seeking enthusiastic volunteers, interns, and pro bono attorneys. This is an excellent opportunity for individuals interested in gaining hands-on experience in legal services, nonprofit operations, and community advocacy. Volunteers/interns will work on a variety of tasks ranging from research and casework to assisting with outreach and administrative functions. We will match pro bono attorneys with time-limited, short term cases/advocacy/projects.
About Us:
At MLSC, we believe in a Micronesia where all people are treated fairly and with respect; where government and institutions are accountable even to the most vulnerable among us; where those who need legal services the most get the highest quality assistance to better their lives; where justice and fairness for all, even the poor, is the standard not only in our courts but in every community; and where communities thrive under democratic principles.
Our mission is to promote equal access to justice and to provide high quality civil legal assistance to low income people. MLSC improves the lives of the people of Micronesia by helping them solve important legal problems; and strengthens communities through advocacy.
Responsibilities (examples):
- Conduct legal research on issues such as family law, civil rights, environmental law, and access to justice.
- Assist in drafting legal documents, reports, and other materials as needed.
- Support case management through data entry, case file organization, and document review.
- Collaborate on special projects, such as workshops or community outreach.
- Contribute to ongoing advocacy efforts, including helping prepare for public hearings or community events.
- Assist in administrative tasks, including organizing files, preparing client materials, and general office support
Qualifications:
- Strong interest in law, social justice, and nonprofit work.
- Excellent written and oral communication skills.
- Ability to work independently and collaboratively with a team.
- Proficiency in working with computers is helpful but not required
- Flexibility in handling various tasks and working in a fast-paced environment.
- Prior legal experience is helpful but not required.
Work Schedule:
This position offers flexibility in scheduling. We will work with you to create a schedule that is mutually convenient.
Benefits:
- This position is unpaid. There is no salary.
- Gain valuable experience in legal services and nonprofit work.
- Opportunity to make a meaningful impact on vulnerable populations.
- Professional development through hands-on projects and mentorship.