- Providence (Walla Walla, WA)
- …admission, allergies, and skilled services needed. Case Manager duties include utilization reviews and management , and support of the discharge planning ... Coordinator-Case Manager coordinates the patient referral, admissions, and case management for the Acute Rehabilitation Unit in collaboration with the attending… more
- Molina Healthcare (Iowa City, IA)
- … (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management ), clinical pharmacy ... **JOB DESCRIPTION** **Job Summary** Molina Pharmacy Services/ Management staff work to ensure that Molina members...initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and… more
- Texas Health Resources (Arlington, TX)
- Director Utilization Management -Clinical Review _Are you looking for a rewarding career with family-friendly hours and top-notch benefits? We're looking for ... system services for wholly owned and Partner hospitals for utilization management . Job Duties OPERATIONS: Plans, organizes...of Texas required upon hire ACM - Accredited Case Manager or CCM, CPHM or Milliman certification preferred upon… more
- Whidbey General Hospital (Coupeville, WA)
- …home health, Hospice, skilled nursing, anti-biotic regime, etc. The RN - Care Manager follows the hospital's Case Management / Utilization Plan that integrates ... of utilization review, discharge planning, and resource management into a singular effort to ensure, based on...resource utilization , the discharge planning and appeal/denial management . The RN - Care Manager serves… more
- Prime Healthcare (National City, CA)
- …EDUCATION, EXPERIENCE, TRAINING Required qualifications 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/224837/discharge-planner utilization - management /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityParadise… more
- Molina Healthcare (Macon, GA)
- …and quality initiatives under the direction of leadership. * Monitors drug utilization and assists leadership team in understanding quality and cost-control issues ... for the upcoming year. * Works with the care management department as part of a member-centered interdisciplinary care...care team (ICT). * Works with the Pharmacy Benefit Manager (PBM) to manage formulary changes and update marketing… more
- Elevance Health (Las Vegas, NV)
- ** Utilization Management Representative I** **Location** : This role enables associates to work virtually full-time, with the exception of required in-person ... to 5:05 PM Pacific. Training hours may vary. The ** Utilization Management Representative I** is responsible for...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Tampa, FL)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... (four 10-hour workdays per week) Monday - Sunday.** The ** Utilization Management Representative I** will be responsible...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Elevance Health (Wallingford, CT)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... an accommodation is granted as required by law._ The ** Utilization Management Representative I** will be responsible...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- University of Utah Health (Salt Lake City, UT)
- …communication skills. + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The ability to ... and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** +… more