Duke University logo
Duke University

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

3 days ago

Salary

0

Seniority

Senior

Bachelor Degree3 yrs expEnglish

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 Categories

Related Job Pages

More Manager Jobs

SWAROVSKI logo

Area Manager

SWAROVSKI

Create a World of Wonder

Manager3 days ago
Full TimeRemoteTeam 10,001+H1B No Sponsor

• 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

United States
Ameresco logo

Site Safety Manager

Ameresco

Ameresco, Inc. is a leading cleantech integrator and renewable energy asset developer, owner and operator.

Manager3 days ago
Full TimeRemoteTeam 1,001-5,000Since 2000H1B Sponsor

• 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

Oklahoma
CVS Health logo

Transitional Care Manager, Social Worker (License Required)

CVS Health

CVS Health is a leading healthcare company operating CVS Specialty, CVS Pharmacy, CVS MinuteClinic, and CVS Caremark. In 2018, CVS combined forces with healthca

Manager3 days ago

• 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.

Pennsylvania
$46.6K - $101.2K / year
General Electric - GE logo

Senior Contract Manager

General Electric - GE

Built on more than 130 years of experience, GE Vernova, a division of General Electric (GE), is leading a new era of energy by electrifying the world while work

Manager3 days ago

Role Description The Contract Manager supports the project team on all contractual issues (ranging from equipment (EO/EEP) and Turnkey (TKP/TKSI) projects) during project execution and ensures that commercial risks and opportunities (notably claims, change orders, vendor and insurance recoveries) are identified early, tracked, managed and resolved favorably to GE. The support includes contract analysis, drafting of contractual documents & correspondence as well as negotiation. - Implement risk mitigation strategies - Develop claims settlement agreements - Manage and drive Contract Change Order execution in accordance with GE entitlement, including pursuing extension of time and other claims against Engineering, Procurement and Construction (EPC) Companies - Pursue, negotiate and obtain insurance claim recoveries - Drive Supplier recovery working in conjunction with Sourcing - Ensure timely and accurate maintenance of databases to track and drive risk mitigation, vendor recovery and insurance recovery - Perform pre-award risk analysis of customer contract terms and conditions - Development and negotiation of terms and conditions with major subcontractors - Ensure appropriate insurance policies are in place for assigned projects - Maintain contract management documentation and electronic files, including contemporaneously obtaining and managing critical back-up documentation for delays, claims, back-charges and rejections - Work closely with Project Managers to ensure timely submission of contractual notifications / deliverables - Draft Change Orders, letters, replies and notifications to customers - Provide contractual analysis and interpretation on project commercial issues and drive to successful resolution and closure - Manage the project handoff from sales to the project management team, including Contract page turn, Contract risk review, Commercial Deliverables, request proof of insurance, oversee payment securities and obtain Management authorization to release new projects via Electronic Order Release system (eARS) in a timely manner - Issue Internal Change Orders as required - Visit customer sites and lead Contract analysis of problems on projects - Prepare and present claims mitigation presentations to customers Qualifications - Bachelor's degree from an accredited university or college with 6+ years of experience in Contracts Management, project management experience in EPC (Engineering, Procurement, and Construction) Power Plants, or similar Requirements - Working hours must be around the EST time zone to accommodate business and clients - Ability to travel to US and Latin America project sites if needed - Contract reading and writing experience - Strong presentation and negotiation skills - Ability to handle many complex issues concurrently - 5+ years claims management experience - Construction claims negotiation experience - Developer or EPC Experience, preferably in the Power Industry - A sense of urgency and customer-focused responsiveness - Ability to speak, read and write in Spanish preferred Benefits - Medical, dental, vision, and prescription drug coverage - Access to Health Coach from GE Vernova, a 24/7 nurse-based resource - Access to the Employee Assistance Program, providing 24/7 confidential assessment, counseling and referral services - Retirement benefits including the GE Vernova Retirement Savings Plan, a tax-advantaged 401(k) savings opportunity with company matching contributions and company retirement contributions - Access to Fidelity resources and financial planning consultants - Tuition assistance - Adoption assistance - Paid parental leave - Disability benefits - Life insurance - 12 paid holidays - Permissive time off

United States
$127.5K - $212.5K / year