- Elevance Health (Tampa, FL)
- …clinical information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- CareFirst (Baltimore, MD)
- …such as evaluating pharmacy benefit structures, reviewing high cost drug utilization and trends, assessing risk tied to specialty medications, and collaborating ... with Pharmacy Benefits Management (PBM) partners to ensure appropriate pricing, risk mitigation,...of the range, as compensation decisions depend on each case 's facts and circumstances, including but not limited to… more
- 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
- Molina Healthcare (Augusta, GA)
- …(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
- Sharp HealthCare (San Diego, CA)
- …leadership experience, preferably in a managed care setting. **Other Qualification Requirements** + Utilization , Case Management , or Quality Management ... Will Do** Supervise the effective implementation of the Ambulatory Case Management (ACM) programs that includes the...and implement new programs under the direction of the Manager of Integrated Care Management and Director… more
- Elevance Health (Indianapolis, IN)
- …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
- 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
- Huntington Ingalls Industries (Coronado, CA)
- … management of the site's accountable assets, including acquisition, utilization , tracking, and disposition. + Administer inventory control and ensure proper ... the Department of Energy's national security mission through the management and operation of its sites, as well as...materials and services. + Work closely with the Logistics Manager and Property Manager to streamline operations.… more