- Excellus BlueCross BlueShield (Rochester, NY)
- …by regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and work closely with Case Management to address ... Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise interacts… more
- Sutter Health (Sacramento, CA)
- …Sutter Health! **Organization:** SHSO-Sutter Health System Office-Valley **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's ... care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity,… more
- CareOregon (Portland, OR)
- …non-dominant groups within Housecall Providers and our communities at large. The quadruple aim is real at Housecall Providers In home medical care for homebound ... on the satisfactory completion of a pre-employment background check, immunization review , and drug screen (including THC/Marijuana). CareOregon is a federal… more
- Sutter Health (San Francisco, CA)
- …Planning and Utilization Management throughout the acute care patient experience. The RN Case Manager works in collaboration with the Physician , Medical Social ... CPMC-California Pacific Med Center Van Ness **Position Overview:** The RN Case Manager is responsible for Care Coordination, Care Transitions, Discharge… more
- Access Dubuque (Dubuque, IA)
- …is also available remotely within Iowa. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned consumers. + Develop, ... preferred. + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review experience strongly...life's toughest moments. To deliver on that promise, we aim to hire, train, and grow the best professionals… more
- Banner Health (Gilbert, AZ)
- …provider networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through ... **Primary City/State:** Gilbert, Arizona **Department Name:** Case Mgmt-Hosp **Work Shift:** Day **Job Category:** Clinical Care Nursing careers are better at Banner… more
- Sutter Health (Emeryville, CA)
- …Sutter Health! **Organization:** SHSO-Sutter Health System Office-Bay **Position Overview:** The Physician Advisor (PA) is a key member of the hospital's leadership ... care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under-utilization of resources, medical necessity,… more
- University Medicine (Providence, RI)
- SUMMARY: Reporting to the Manager of Case Management, the nurse case manager is responsible for providing comprehensive screenings, assessment, care coordination ... intent of encouraging self-management for patients with chronic conditions. The Nurse Case manager is integrated in the office-based healthcare team and thereby has… more
- CareOregon (Portland, OR)
- …non-dominant groups within Housecall Providers and our communities at large. The quadruple aim is real at Housecall Providers In home medical care for homebound ... on the satisfactory completion of a pre-employment background check, immunization review , and drug screen (including THC/Marijuana). CareOregon is a federal… more
- Elevance Health (Indianapolis, IN)
- …state mandated policies, and CMS Coverage Determinations, as applicable. + Perform physician -level case review of utilization requests for procedures ... reviews for their board certified specialty. + Makes physician to physician calls to gather medical...necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director… more