- KPH Healthcare Services, Inc. (Hoffman Estates, IL)
- …activities, educational programs, and departmental/branch meetings. + Drives the Primary Case Management Model (PCMM) in daily interactions through the ... to patients, nurses and physicians as required regarding the contents, utilization , therapeutic actions, possible adverse reactions, or interactions of drugs. +… more
- Deloitte (Washington, DC)
- …multiple engagements and priorities simultaneously, ensuring efficient and effective project management and resource utilization . + The Team Deloitte Tax's ... role and compensation decisions are dependent on the facts and circumstances of each case . A reasonable estimate of the current range is $146,510 to $272,090. You… more
- UNC Health Care (Rocky Mount, NC)
- …discharge planning priorities. 2. Assist in Facilitating Discharge Planning. 3. Assist in Utilization Management Process. 4. Complete FL2 for Long Term Care and ... Notice, assisting in facilitating discharge planning, and assisting in utilization management processes. 7. Performs other duties...Hospitals Entity: Nash UNC Health Care Organization Unit: NGH Case Management Work Type: Full Time Standard… more
- Molina Healthcare (AZ)
- …(CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of America (CMSA) ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies… more
- Elevance Health (Louisville, KY)
- …Capabilities, and Experiences:** + Prior claims experience is strongly preferred. + Utilization Management experience is strongly preferred. + Health insurance ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- CVS Health (Springfield, IL)
- …meet the requirements of the position **Preferred Qualifications** + Certified Case Manager + 3+ years Care Management , Discharge Planning and/or Home Health ... TOC team will review prior claims to address potential impact on current case management and eligibility status. Assessments and/or questionnaires are designed… more
- Sevita (Tucson, AZ)
- …care, advocacy, stakeholder relations, regulatory compliance, staffing, training, financial management , and maintenance of the physical environment. **ESSENTIAL JOB ... be able to satisfactorily perform each essential function listed below._ **Staff Management :** 1. Recruitment & Hiring: May participate in hiring events as needed… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …clinical nursing experience, including behavioral/mental health + Experience in a managed care, case management , or utilization review setting + Strong ... on clinical guidelines and insurance coverage. + Provide telephonic and/or in-person case management and member education regarding conditions, medications, and… more
- Federal Communications Commission (Washington, DC)
- …agency objectives, justifies and defends resources requirements to senior level management , ensuring efficient utilization of allocated resources. Ensures ... and purchase card activities and projects; and reviews and prepares related management reports and other performance measures. Analyzes and evaluates controls to… more
- Carle Health (Peoria, IL)
- …to improve access to care and achieve optimal clinical outcomes. Qualifications Certifications: Certified Case Manager within 2 years - Commission for Case ... bonus - External candidates with at least 1 year of experience The OP Care Management RN provides care management and population health services to patients. The… more