- State of Colorado (Denver, CO)
- …systems, using basic software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably in an ... medical services providers, designated and non-designated trauma centers, long term care facilities and many other specific types of healthcare services. The… more
- Highmark Health (Denver, CO)
- …partners and stakeholders across the organization. Key responsibilities will include clinical review , assisting in navigating a complex regulatory environment, ... Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but not limited to:… more
- State of Colorado (Denver, CO)
- …systems, using basic software applications, and communicating through email is required. + Non- clinical or clinical health care experience, preferably in an ... medical services providers, designated and non-designated trauma centers, long term care facilities and many other specific types of healthcare services. The… more
- Elevance Health (Denver, CO)
- …and patients' office visits with providers and external physicians. + Applies clinical knowledge and skills to utilization review processes. + Adheres ... + As assigned, engage in clinical and non- clinical activities that impact health care quality...or territory of the United States when conducting utilization review or an appeals consideration and cannot… more
- Evolent (Denver, CO)
- …engagement to help ensure high value care delivery.** + Offer ** clinical rationale for standard and expedited appeals ,** ensuring compliance with UM ... We Offer:** + A unique opportunity to **impact patient care beyond direct clinical practice.** + A...+ **Computer proficiency** and ability to navigate electronic medical review platforms. + No current exclusions, sanctions, or disciplinary… more
- Prime Therapeutics (Denver, CO)
- …for drug infusion services versus the hospital outpatient facility.Discusses financial and clinical considerations with members who are considering care at a ... these cases in web-based application and spreadsheets. + Supports clinical services such as the appeals program....+ Experience in managed care , specialty drugs, care management and utilization review . + Meets… more
- State of Colorado (Denver, CO)
- …Relevant years of State service experience + Degree in criminal justice, clinical psychology, forensic psychology, sociology, human services or related field + ... understand and apply treatment modalities to provide adequate patient care . + Demonstrated ability to understand treatment plans and...appeal with the State Personnel Board or request a review by the State Personnel Director. An appeal or… more
- State of Colorado (Pueblo, CO)
- …services, and a community partner. CMHHIP is a 24 hour behavioral health acute care facility that is intended to provide a safe, secure, and therapeutic setting for ... a multidisciplinary treatment team. This includes: 24 hour nursing care and assessment; psychiatric intervention and evaluation; psychological services;… more
- State of Colorado (Grand Junction, CO)
- …assess the care , treatment and quality of life provided by health care facilities through observations, interviews, and record review . + Uses experience, ... , treatment and quality of care and life as provided by health care facilities through observations, interviews, and record review . + Experience and ability… more
- Humana (Denver, CO)
- …**Required Qualifications** + MD or DO degree + 5+ years of direct clinical patient care experience post residency or fellowship, which preferably includes ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Begins to influence department's… more