- The Cigna Group (Bloomington, MN)
- …requires the combination of a strong clinical background, deep understanding of utilization management criteria, and ability to read pharmaceutical contracts, ... Strategic Markets is responsible for assessing formulary positioning alongside applicable utilization management policies to determine client eligibility for… more
- Community Health Systems (Valparaiso, IN)
- … is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of ... care, cost efficiency, and patient outcomes. + Prepares and delivers reports on utilization , care management performance, and variance from expected outcomes to… more
- Calvary Hospital (Bronx, NY)
- …PRI Assessor required. + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or ... identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review, Discharge Planning, Risk Management , and Quality Assessment and… more
- Elevance Health (Miami, FL)
- …Excel. + Previous clinical experience at a skilled nursing facility or utilization management experience strongly preferred. Please be advised that Elevance ... **Medical Management Clinician Associate** **Locations:** Tampa, FL or Miami,...a minimum of 2 years of clinical experience and/or utilization review experience. + Current active, valid and unrestricted… more
- Wolters Kluwer (Wilmington, DE)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + **Ongoing Utilization Management ** + Oversee and analyze customer utilization ... Engagement Manager plays a high-impact role in managing strategy and product utilization across the Wolters Kluwer Health's Clinical Decision Support & Provider… more
- Eastern Connecticut Health Network (Manchester, CT)
- …timely and accurate information to payers. The role integrates and coordinates utilization management and denial prevention by focusing on identifying and ... for preoperative, concurrent, and retrospective reviews in accordance with the utilization management plan. The UM CM ensures the appropriate status and level… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …health care administration, or nursing. + Extensive knowledge of payer mechanisms and clinical utilization management is required. + A minimum of five years of ... in Healthcare Quality (CPHQ), Certified Case Manager (CCM), Certified Professional Utilization Management (CPUM), Certified Professional Utilization Review… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more
- Sharp HealthCare (San Diego, CA)
- …competency and individual development planning process.Maintain current knowledge of case management , utilization management , and discharge planning, as ... policy.Identify opportunities for cost reduction and participate in appropriate utilization management venues.Escalate and refers cases for consultation… more
- Nuvance Health (Danbury, CT)
- …standardization of policy, procedure and approach to physician advisor roles in utilization management , , documentation and denials/downgrades. * Serves as ... and provides support to care team and denial prevention and denial management team members regarding utilization decisions including screening for… more