Duke University, a private research university located in Durham, North Carolina, is an institution "fueled by creativity" and "informed by scholarship." Founde
Utilization Manager
Location
North Carolina
Posted
10 days ago
Salary
0
Seniority
Senior
Job Description
Utilization Manager
Duke University
• Assesses for accuracy in the assignment of patient class (status) • Supports the medical chart audit process • Supports denials management by documenting activities related to denials adjudication • Validates authorization for all bedded patients • Manages concurrent cases to resolution • Conducts initial review and continued stay reviews • Collaborates with members of the healthcare team
Job Requirements
- Education BSN required
- Minimum of three years recent acute clinical practice or related health care experience
- Requires Case Management Certification (ACM, CCM or ANCC) within 2 years of hire
- Must have current or compact RN licensure in state of NC
- BLS certification required
Benefits
- Relocation Assistance (based on eligibility)
- Quality of Life: Living in the Triangle!
- Flexible work arrangements
Related Guides
Related Categories
Related Job Pages
More Manager Jobs
• Manage sustainable sales performance within Area and ensure sales and profitability targets are met while maintaining tactical and fiscal integrity • Create a culture focused on delivering exceptional customer experiences • Strive for excellence in every customer interaction utilizing the service steps in the Swarovski service and sales program • Assist store teams in building a loyal portfolio of customers by establishing strong relationships with existing customer and actively recruiting new customers to the Swarovski loyalty programs • Be an advocate and role model, demonstrating with active passion, enthusiasm and integrity • Manage implementation of all Swarovski policies, procedures and operational processes • Ability to work cross functionally with a variety of different teams and leaders including executive teams • Recruit, develop and retain best in class talents and secure a succession plan in order to meet requirements for a luxury customer experience • Ensure all performance management standards are met, including but not limited to tracking disciplinary actions and rewarding employees where appropriate, addressing complaints and resolving problems, executing Performance reviews, and other company initiatives
Site Safety Manager
AmerescoAmeresco, Inc. is a leading cleantech integrator and renewable energy asset developer, owner and operator.
• Prepare the Site-Specific Safety Plans and Activity Hazard Analysis for assigned Business Unit projects • Ensure compliance to all Safety Policies and adopted Standards • Ensure personal protective equipment meets applicable OSHA/EPA requirements and employees are trained on proper use • Conduct Safety Audits of assigned project sites ensuring work is being accomplished safely and occupational health is not compromised • Conduct project safety inspections with follow-up inspections of any open items • Review Subcontractor safety qualifications and attend Pre-Construction Meetings • Creation and evaluating activity hazard reviews • Regulatory compliance with OSHA and Ameresco standards and conducts accident and incident investigations • Development and Implementation of Corrective Action Plans • Work with project supervision to create safety solutions to safety problems • Foster and maintains a positive safety culture for the project personnel • Maintain all safety certifications as required by contracts • Conduct quarterly safety meetings for Project Staff • Produce Safety Reports of activities performed • Maintain a positive work atmosphere by acting and communicating in a manner to get along with customers, co-workers, supervisors, and management • Lead Incident/accident Investigations • Perform other duties as required
Transitional Care Manager, Social Worker (License Required)
CVS HealthCVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca
• Manage patients through transitions of care, either face to face in the facility or telephonically, within a defined geographical area and care setting. • Advocate for the patient throughout the care continuum to ensure access to resources and resolution to all barriers to care. • Establish relationships and ensure patient/family are informed of patient condition, plan of care and discharge plan, all discharge instructions, medication reconciliation; rationale of Utilization Management determinations and any financial information associated with such, potential for LTC transition (if applicable) and importance of timely PCP follow-up following discharge. • Identify opportunities for improved program workflows, increased internal and external partnerships, and higher quality patient care. • Maintain real-time and accurate records of patient status through care transitions within Oak Street's internal inpatient platform. • Adhere to CMS, state specific and NCQA compliance criteria as related to Transitions of Care. • Coordinate with the Utilization Management team to review medical and payer records to ensure appropriate length of stay and identify any barriers to discharge. • Participate in regular inpatient and post-acute rounding calls with Care Navigation and Utilization Management teams to help determine patient status and appropriate discharge plan. • Assist Utilization Management team with access to external medical record information (if available) when needed to make appropriate determinations. • Collaborate with other transitions team members (e.g., Transitional Care Managers - RN and Transitional Care Coordinators) to ensure safe discharge and timely follow up. • Communicate and coordinate with internal stakeholders to identify and address patient needs (e.g., care team, social work, behavioral health, utilization management, Hard-to-Reach, Central Telehealth, etc.). • Participate in regular meetings with Oak Street Health regional leaders to coordinate program implementation and ongoing management. • Engage directly with inpatient physicians, case managers, medical directors, social workers, and SNFists (where applicable) to facilitate safe and timely discharge, appropriate follow-up care, and next steps. • Participate in initial and ongoing required training to ensure appropriate implementation of transitions activities and programming. • Follow program procedures for documenting and tracking transitions interventions. • Other duties, as assigned.
Role Description The Credit department at Revolut is anything but ordinary. They design, develop, and launch credit products across the globe. The team manages our products from day one to the end - developing the back and front-end, the data science infrastructure, and then creating a local setup in each country with scalable risk management and portfolio management solutions. As a Mortgage Credit Manager, you'll be responsible for designing the credit risk policies, procedures, and strategies around launching Revolut's mortgage retail lending in Lithuania. This is a new-ish product in our portfolio, and as that book grows, you'll be managing validation of the underwriting strategy, as well as leading the charge for preventative and reactive actions to the market and product offering. Up to shape the future of finance? Let's get in touch. What you'll be doing - Creating mortgage lending policies, procedures, and frameworks - Helping to build and scale global underwriting systems that balance risk, operational efficiency, and seamless customer experience - Making data-driven decisions with a special focus on marginal decision-making - Managing credit limits, risk-based pricing, retention strategies, regulatory changes, new feature launches, etc. - Adjusting risk return requirements and managing/adjusting portfolio returns as new data comes to light - Supporting the annual budget, sales forecast, and planning processes by assessing market/industry trends through data gathering and analysis - Conducting quality assurance reviews to ensure decisions are accurate, consistent, and compliant - Providing training and mentorship to strengthen credit risk management awareness and foster a positive risk culture - Contributing to product development and funnel optimisation initiatives while supporting the Mortgage Product Manager in building a best-in-class product - Tracking, communicating, and drawing insights from performance of ongoing initiatives while staying on top of credit KPIs through intensive monitoring - Ensuring approval and good rating of first-line credit risk function from second line, third line, and regulators Qualifications - A proven track record of managing credit risk for mortgage products and/or credit cards, unsecured personal loans, etc. - A bachelor's degree in a quantitative/analytical field like economics, management, maths, engineering, statistics from a top university - A solid understanding of credit policy governance framework, credit risk models, and the value of speed to market - Knowledge to work through 2nd/3rd line of defence in a competent manner - To be forward-thinking on inter-dependencies to proactively identify and resolve issues - The ability to explain complex concepts in simple manner - Critical thinking skills capable of processing a lot of information for optimal decision-making - Excellent working knowledge of SQL and other data analysis tools, and a willingness to learn new technology to help the business scale Nice to have - A master's degree - Proficiency in R and Python Important notice for candidates - Job scams are on the rise. Please keep these guidelines in mind when applying for any open roles. - Only apply through official Revolut channels. - We don't use any third-party services or platforms for our recruitment. - Always double-check the emails you receive. - Make sure all communications are being done through official Revolut emails, with an @revolut.com domain. - We won't ask for payment or personal financial information during the hiring process. - If anyone does ask you for this, it's a scam. Report it immediately.



