- Elevance Health (Viroqua, WI)
- …chronic illnesses, co-morbidities, and/or disabilities, to ensure cost effective and efficient utilization of long-term services and supports. + At the direction of ... and may be involved in process improvement initiatives. + Submits utilization /authorization requests to utilization management with documentation supporting and… more
- LA Care Health Plan (Los Angeles, CA)
- …claim adjudication process through medical record review for Payment Integrity and Utilization Management projects. The position serves as a subject matter expert ... include inpatient, outpatient, and professional claims. Serves cross functionally with Utilization Management, Medical Directors, and other internal teams to assist… more
- Texas Health Resources (Dallas, TX)
- …resources. Assesses patient information utilizing psychological and medical knowledge. Utilization Review and Management * Performs effective utilization ... review according to department identified criteria to determine the appropriate utilization of resources and patient level of care. Reviews daily patients admitted… more
- CVS Health (Springfield, IL)
- …in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... programs and commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy revisions/reviews. - Directors will… more
- Danaher Corporation (Houston, TX)
- …care improvement opportunities including but not limited to early id, resource utilization in high scrutiny workflows, and antibiotic stewardship. + The CSE will ... be accountable to ensuring that the customer goals for test implementation and utilization are well defined and within an appropriate scope of expectations. The CSE… more
- Charter Care Health Partners (North Providence, RI)
- …specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge ... planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality and cost effectiveness of patient care and… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of CCA's mission, value-based approach, and expectations for quality, utilization , and member experience. * Address provider inquiries related to care ... coordination, utilization management, and program participation, collaborating with internal teams...Insight * Analyze and interpret provider data related to utilization , cost, quality, and outcomes to identify performance trends… more
- Charter Care Health Partners (North Providence, RI)
- …specific patient population. Performs functions related to Patient Advocacy; Utilization Review; Resource Management; Continuum of Care Management (Discharge ... planning) and Clinical Documentation Management. Collects data via utilization with Care Port to enhance the quality and cost effectiveness of patient care and… more
- Centene Corporation (Lansing, MI)
- …Experience with table creation and indexing, query optimization, and utilization of stored procedures. Working knowledge of SQL/querying languages. Experience ... with table creation and indexing, query optimization, and utilization of stored procedures. Preferred knowledge of programmatic coding languages such as Python and… more
- Children's Hospital Los Angeles (Los Angeles, CA)
- …illnesses. Focuses on patients with complexities related to finance and/or resource utilization . Acts as advocate for the patient/family by collaborating with the ... nursing experience with advanced level pediatric clinical experience and utilization management and/or discharge planning experience. Thorough knowledge of managed… more