- State of Colorado (Pueblo, CO)
- SOCIAL WORK/COUNSELOR III- Clinical Work Lead COT Print (https://www.governmentjobs.com/careers/colorado/jobs/newprint/5042105) Apply SOCIAL WORK/COUNSELOR III- ... Clinical Work Lead COT Salary $82,620.00 - $115,668.00 Annually...when deemed necessary. Works with Unit Management Teams to review Unit Schedule and group needs to suggest appropriate… more
- US Tech Solutions (May, OK)
- …Pharmacist/ Clinician is an operation-based role that conducts criteria based & clinical review of medical data collected to perform prior authorization as ... per policy and procedure. + The Pharmacist/ Clinician will apply clinical knowledge to plan...urgent PA request as needed. **Responsibilities:** + Evaluate and review all prior authorization requests and render coverage determinations… more
- Whitney Young Health Center (Albany, NY)
- …to continually assess and improve the quality of patient services-conducts monthly utilization review . + Participates in the recruitment of clinical staff. + ... Clinical Supervisor - Substance Use Disorder Programs (Req...patient access to care, enhance program census, and achieve clinician productivity standards. + Leads and engages clinicians in… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in...clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care… more
- UPMC (Pittsburgh, PA)
- …and stakeholders to develop and execute on our population health strategy, clinical and provider operations, and State contract and CMS requirements for the ... the Quadruple Aim of better health, better care, lower costs, and higher clinician satisfaction. The role is primarily working with health plan Medicare (including… more
- Commonwealth Care Alliance (Boston, MA)
- …medical, behavioral, and social needs. The RN uses evidenced-based care approaches, clinical skills, education, and training to influence the clinical outcomes ... communities across various locations. This position reports to the CIC APC Clinical Manager. **Supervision Exercised:** No, this position does not have direct… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …needs across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets ... a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members. Your Responsibilities *… more
- Cardinal Health (Sacramento, CA)
- …+ Take any action necessary for any denials received by the payor to inform the clinician of changes that may need to happen to not delay patient care. + Complete ... any pre-service appeals to obtain paying approval based on medical necessity....Communicate effectively with all Revenue Cycle Management staff and clinical staff to ensure appropriate treatment can be provided,… more