- Elevance Health (Atlanta, GA)
- …information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med Review). + Provides ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- Elevance Health (Washington, DC)
- …information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med Review). + Provides ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- Elevance Health (Indianapolis, IN)
- …information regarding case and determines appropriate area to refer or assign case ( utilization management , case management , QI, Med Review). + Provides ... reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation of clinical… more
- Highmark Health (Harrisburg, PA)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review, the incumbent participates as the physician member...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- The Cigna Group (St. Louis, MO)
- …existing clients with close attention to detail and accuracy + Review custom Utilization Management policies for rebate eligibility or adherence to contract ... manager and in close partnership with business partners + Support standard utilization management review as needed + Create client presentations and present to… more
- Centene Corporation (Jefferson City, MO)
- …Purpose:** Lead a team of medical directors and supervise MD's responsible for utilization management and appeals functions to ensure members receive medically ... stakeholders across the enterprise. + Provide medical leadership for all utilization management (appeals), pharmacy, case management , disease management ,… more
- Highmark Health (Pierre, SD)
- …This role supports the full application product lifecycle for **clinical and utilization management software** , with a specific focus on driving ... They function as a pivotal bridge, translating high-level **clinical and utilization management software** business needs into detailed technical requirements… more
- Molina Healthcare (Green Bay, WI)
- …of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies ... the most appropriate care at the most effective setting. *Evaluates effectiveness of utilization management (UM) practices - actively monitoring for over and… more
- Health Care Service Corporation (Chicago, IL)
- …the delegated entity reporting requirements to include claims delegation, utilization management delegation and credentialing delegation.8.Respond to provider ... problems. Must work closely with the Pricing, Full Service Units, Utilization Management , Medical, Delegation Oversight, Core Credentialing, Provider Automation… more
- Centene Corporation (Salem, OR)
- …+ Must be licensed in Oregon + American Board Certification + Utilization Management experience and knowledge of quality accreditation standards highly ... functions for the business unit. + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities +… more