- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …an individualized case plan outlining family needs, goals and services. Service Utilization UM/Wrap: This is strongly recommended in order to manage and track ... the daily service utilization log, monitors costs and tracks 3rd party resources....resources and adhere to policies and procedures. Responsible for utilization and monitoring flexible funding and service coordination in… more
- Evolent (Helena, MT)
- …As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... to assure consistency in the MD review process to reflect appropriate utilization and compliance with SBU`s policies/procedures, as well as Utilization … more
- US Tech Solutions (Columbia, SC)
- …+ Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or ... clinical guidelines. + Provides support and review of medical claims and utilization practices.. **Responsibilities:** + May provide any of the following in support… more
- Hartford HealthCare (Mansfield Center, CT)
- …individual in this role provides clinical staff with guidance on documentation, utilization , and patient care decisions to support optimal clinical and operational ... outcomes. They review visit utilization for care appropriateness and collaborate with clinicians on...quality and reliability. Guides staff on clinical, documentation, and utilization decisions to improve OASIS accuracy and care quality,… more
- Molina Healthcare (Reno, NV)
- …in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS), ... more of the following activities: care review, care management, utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), transition… more
- University of Southern California (Arcadia, CA)
- …and accurate information to payers. The role integrates and coordinates utilization management, care facilitation, and discharge planning functions. The Case ... meet patient needs, manage the length of stay, and promote efficient utilization of resources. Specific functions within this role include: facilitation of… more
- CVS Health (Baton Rouge, LA)
- …consumer-focused, and acknowledges physicians for their clinical excellence and effective utilization of health care resources. Reporting to the Executive Behavioral ... Health Medical Director, Aetna Medicaid, this role is responsible for utilization , quality, and fraud, waste, and abuse reviews for individual cases involving… more
- Air National Guard Units (Eielson AFB, AK)
- …and software and develops base wide network operating procedures. Analyzes LAN utilization statistics through data collection and performance measures to ensure the ... standardization based on current and projected customer needs. Analyzes LAN utilization statistics, performance measures, and system profiles to ensure network… 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 referred ... 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
- HCA Healthcare (Austin, TX)
- …environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in the inpatient ... medical staff regarding clinical resource management, appropriate documents standards, utilization and quality issues, and quality improvement activities, in… more