- University of Southern California (Los Angeles, CA)
- …to multi-task. Preferred Qualifications: + Pref Bachelor's degree + Pref 1 year Case management or utilization review experience within the last three years ... The RN case manager role integrates the functions of utilization management , quality management , discharge...Participates in InterQual competency testing as requested by department director . + Outcomes Management * Participates in… more
- Gilead Sciences, Inc. (Foster City, CA)
- …the lives of patients for generations to come. Reporting to the Executive Director of Global Medical Affairs Technology, this individual will be responsible for ... our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include...on the project status and budget to the Executive Director of Medical Affairs Technology + Be the primary… more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- The Cigna Group (St. Louis, MO)
- …from manager and in close partnership with business partners + Support standard utilization management review as needed + Create client presentations ... clients with close attention to detail and accuracy + Review custom Utilization Management policies...with little to no modeling oversight by Sr. Manager/Clinical Director + Identifies and recommends process improvement to streamline… more
- Johns Hopkins University (Baltimore, MD)
- …plan functions such as claims processing, premium billing, encounter data, utilization management , risk adjustment, provider contracting, quality metrics, and ... on assigned management committees and speak for department when Executive Director Internal Audits, Associate Directors and Chief Audit Officer are not present.… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as… more
- Elevance Health (Richmond, VA)
- …required. + Requires a minimum of 6 years of clinical experience and/or utilization review experience. + Requires HS diploma or equivalent. **Preferred ... in process improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and… more
- WellSpan Health (Lewisburg, PA)
- …the system, within a culture of quality, safety and efficient care. Assists the Director of Clinical Operations in management of staff to deliver high quality, ... practice and across transitions of care. + Responsible for hiring, performance review of Clinical Supervisors. + Collaborates with Practice Managers to provide… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …Analysis Service Line Manager works under the direction of the Value Analysis Director and is responsible for supporting and facilitating service line team(s) in ... and experience, while fostering standardization and reduction in cost and utilization . + Leads and manages cross functional Value Analysis teams/clinical specialty… more
- Elevance Health (Miami, FL)
- …diploma or equivalent, and a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted LPN/LVN or ... Excel. + Previous clinical experience at a skilled nursing facility or utilization management experience strongly preferred. Please be advised that Elevance… more