- KPH Healthcare Services, Inc. (Maumee, OH)
- …to patients, nurses and physicians as required regarding the contents, utilization , therapeutic actions, possible adverse reactions, or interactions of drugs. + ... in all clinical activities as required, including start of care prospective review of medical and drug histories, pharmacokinetic dosing, dosage monitoring for… more
- The Cigna Group (Bloomfield, CT)
- …Care Management, and Health / Wellness programs (eg, utilization management, case management, demand management, medical review , care plans, health care ... coaching, incentives, etc.) + Health Profiles / History (eg, health assessments, electronic medical records, etc.) + Health Measurement (population health, evidence-based medicine, episodes of care, gaps in care, health risk scores, next best actions, HEDIS,… more
- Cedars-Sinai (Beverly Hills, CA)
- …transitioning to the Skilled Nursing Facilities, refers to nurse practitioner and case manager assigned to the SNF's for continued review and follow up. + ... Little More About What You Will be Doing** The Case Manager is responsible for the ...of care and level of care. Use evidence based review guidelines to conduct utilization review… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Coordination is responsible for system-wide Care Coordination functions ( Utilization Review , Social Work, Navigation, and Case Management) including the ... A minimum of five to seven years of leadership experience in care coordination, case management, or utilization review , in an integrated healthcare delivery… more
- Molina Healthcare (Green Bay, WI)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... Management (CPHM), Certified Professional in Health Care Quality (CPHQ), Commission for Case Manager Certification (CCMC), Case Management Society of… more
- Northwell Health (Bay Shore, NY)
- …follow up and action. + * Acts as a liaison with patients insurance carrier ( case manager , utilization reviewer) to coordinate post hospital services and ... to the Hospital. Job Responsibility + * Performs concurrent review on all patients and share all problematic cases...as required. + * Participates in the maintenance of Utilization Management, Discharge Planning and Case Management… more
- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational ... Bachelor's Degree Health care related field **Other Qualification Requirements** + Utilization , Case Management, or Quality Management certification preferred.… more
- Baylor Scott & White Health (Temple, TX)
- …responsible for assessing and coordinating patient care across the continuum to include case management, social work, utilization review and care ... **JOB SUMMARY** Manager Comphrensive Care Management RN manages the activities...ongoing problem solving related to care coordination, discharge planning, case management and utilization review .… more
- Elevance Health (Miami, FL)
- …to members and providers. **How you will make an impact:** + Perform physician-level case review , following initial nurse review , of Medical Oncology ... regimens and supportive care. + Perform physician-level case review , following initial nurse review...maintain knowledge of relevant policies and regulations pertaining to utilization review of oncology care. + Participate… more
- University of Michigan (Ann Arbor, MI)
- …+ Minimum of five (5) years progressive leadership experience in acute care, case management, social work, utilization review , or discharge planning. ... Program Oversight + Ensure highly effective departmental operations, including access, utilization review , care coordination, transition of care, clinical social… more