- John Muir Health (Walnut Creek, CA)
- …of the 340B program. Reports any deficiencies identified during auditing and review for appropriate resolution. + Ensures that the 340B pharmacy program is ... adequate systems checks are reviewed to prevent future billing issues. + Monitors utilization records and 340B purchasing accounts to ensure that software or tools… more
- RxBenefits (Charlotte, NC)
- …channel management, B/G classifications, specialty designations, rebate eligibility, utilization trend, Utilization Management (UM) implications, Manufacturer ... structure, new prospect member size, marketing agreements, broker commissions, and drug utilization . + Be the SME on dozens of medical vendor/PBM contracts including… more
- CommonSpirit Health (Englewood, CO)
- **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... system's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management and… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... *Description* *FULL TIME DAY SHIFTS- VARIABLE HOURS / WEEKEND ROTATIONS REQUIRED* * *Hybrid/ Remote * * *Summary:* The purpose of the Denial Prevention Nurse is to… more
- Banner Health (AZ)
- …a variety of career opportunities and innovative employment options by offering remote and hybrid work settings. The Registered Nurse RN Medical Management Services ... tool for contracted and noncontracted status,) and more. The RN Medical Management Services review Medicare Managed Care plans and receive case reviews via fax and a… more
- Ascension Health (Austin, TX)
- …Case Management + **Subspecialty:** Physician Advisor + **Schedule** : Full Time | Remote (with some on-site prescense required) + **Call Schedule:** No call + ... (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to join a… more
- Actalent (Rancho Cordova, CA)
- Job Title: Utilization Review Nurse Job Description The Registered Nurse will review cases for medical necessity across all levels of care, ensuring that ... patients receive appropriate and necessary treatment. Responsibilities + Review medical cases for necessity at all levels of care. + Utilize strong clinical and… more
- Cuyahoga County Board of Developmental Disabilities (Cleveland, OH)
- …the Prior Authorization Review Process, implementation of AAI Administrative Review , and utilization of Medicaid State Plan Services. Deliver technical ... coaching and instruction to ensure skill acquisition, retention and utilization . Specifically provide oversight to ensure timely enrollment and redetermination… more
- Ochsner Health (New Orleans, LA)
- …3 years of hospital-based experience in discharge planning, case management or utilization review . **Certifications** Required - Current registered nurse license ... of the conditions of participation as it relates to utilization review and discharge planning. + Maintains...determine whether the position you are interested in is remote or on-site._** _Individuals who reside in and will… more
- CenterWell (Phoenix, AZ)
- …medical guidance and expertise. + Develop, implement and monitor the outcomes of utilization review and disease management programs to meet the quality and ... care being provided meets appropriate standards and to ensure cost-effective utilization practices. + Oversee the development, revision, and implementation of… more
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