- Humana (Little Rock, AR)
- …knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- Humana (Indianapolis, IN)
- …knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review ... group practice management. + Utilization management experience in a medical management review organization, such as Medicare...with Case managers or Care managers on complex case management, including familiarity with social… more
- AdventHealth (Daytona Beach, FL)
- …or more years of cancer registry abstraction experience + Strong understanding of complex medical conditions and surgical procedures to make clinical judgements ... other conferences and training as appropriate. + Participates in Quality Assurance peer review , as a reviewer and reviewee. Timely correction of abstractions… more
- Centene Corporation (Jefferson City, MO)
- … review activities pertaining to utilization review , quality assurance, and medical review of complex , controversial, or experimental medical ... plan leaders and cross functional stakeholders across the enterprise + Provide medical leadership for all utilization management, pharmacy, case management,… more
- HCA Healthcare (Austin, TX)
- …Offers clinical support for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level ... corporate to train and support quality improvement, risk management, patient safety, case management, medical staff affairs, and physician relations activities.… more
- The Cigna Group (Bloomfield, CT)
- …including case management (CM), utilization management (UM), and escalated case review . Ensures policies, procedures, and governance frameworks are in ... in medical management functions such as utilization management (UM), case management (CM), policy development, and governance. Proven ability to navigate … more
- Idaho Division of Human Resources (ID)
- …ensuring the legal rights of clients are protected at every level. + Develop case strategies, investigate facts, and review evidence to determine the best course ... work under general supervision in exercising and performing more complex cases in magistrate court. Example of Duties +...of clients are protected at every level; + Develop case strategies, investigate facts, and review evidence… more
- Elevance Health (Los Angeles, CA)
- …Rotating Weekends and holidays. The ** Medical Management Nurse** is responsible for review of the most complex or challenging cases that require nursing ... not in line with diagnosis. + Provide consultation to Medical Director on particularly peculiar or complex ...skills and nursing judgment and experience. + Collaborates with case management nurses on discharge planning, ensuring patient has… more
- Immigration and Customs Enforcement (Washington, DC)
- …national process changes identified by unit chart reviews, nursing incident reports, Medical Quality Management Unit (MQMU) review /reports, and any corrective ... HSA (in the absence of the NM) by providing training and completing onsite review of nursing competencies during TDY assignments to ensure they are following IHSC… more
- J&J Family of Companies (Irvine, CA)
- …Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less ... profoundly impact health for humanity. Learn more at https://www.jnj.com **Job Function:** Medical Affairs Group **Job Sub** **Function:** Medical Writing **Job… more