- Elevance Health (Tampa, FL)
- …complexity. **How you will make an impact:** + Oversees case and utilization management execution/decision making for managed member populations. + Is accountable to ... Healthcare Management Program including disease management, case management, and utilization management. + Partners with Provider Relations, Quality Management,… more
- Catholic Health Services (Roslyn, NY)
- …Then you have what it takes to be a St. Francis Hospital & Heart Center(R) RN . You are at the heart of health. St. Francis Hospital, The Heart Center(R) is New ... compliance with regulatory and external review agencies. + Participates in the Utilization Management Committee, reporting data on utilization trends, resource … more
- Providence (Olympia, WA)
- …**Physician Relations:** Build strong cooperative relationships with physicians. + ** Utilization Management Oversight:** Lead the Utilization Management ... Master's Degree preferred. + **Clinical Experience:** At least 2 years as an RN in an acute care setting. + **Leadership Experience:** Minimum 3 years managing… more
- US Tech Solutions (RI)
- …+ Must have experience with Medcompass + Must have prior authorization utilization experience. + Managed Care/Medicare experience preferred. **Skills:** + MUST HAVE ... and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF...MUST HAVE 6 months of Prior Authorization. **Education:** + RN with current unrestricted state licensure **About US Tech… more
- Wellpath (Franklin, TN)
- …Graduation from an accredited School of Nursing or Care Management Certification + RN preferred EXPERIENCE + Previous utilization review and/or case management ... you make a difference** The Regional Care Manager (RCM) is responsible for utilization review, care coordination, and daily care management across multiple sites and… more
- Evolent (Springfield, IL)
- …focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and procedures ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
- HCA Healthcare (Sun City Center, FL)
- …As our Director, you willprovide direction to ensure the facilitation and utilization of diverse strategies and communication for quality and performance improvement ... Business Administration, Healthcare Administration, or other related field + Current FL RN license preferred + CPHQ (Certified Professional in Healthcare Quality) OR… more
- Organon & Co. (Dover, DE)
- …as well as other extended account team members to maximize appropriate utilization of Organon products. Integrates Senior Leadership into the overall business ... regional level, as required. Leads Organon 's efforts to maximize appropriate utilization of its portfolio while bringing resources and solutions to customers that… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …support or process improvements are needed\. **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases as ... to ensure effective implementation of interventions, and to ensure efficient utilization of benefits\. + Performing the essential activities of case management:… more
- Billings Clinic (Billings, MT)
- …and administrative support. Works collaboratively with the Physician, Non-Physician Provider, RN , LPN, and other departmental personnel to meet the physical, ... of co-pays. *Screens incoming telephone calls for appropriate referrals to nurse , physician and/or non-physician provider. *Orders and maintains clinical and office… more
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