- Molina Healthcare (Sterling Heights, MI)
- …health oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs ... - working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- CareFirst (Baltimore, MD)
- …**Experience:** 8 years clinical practice experience. **Preferred Qualifications:** + Experience in utilization management or served as physician advisor for ... **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review, care management and quality to determine the medical… more
- Penn Medicine (Philadelphia, PA)
- …ensure lowest price paid. + Works to identify opportunities for standardization and utilization management within a product categories and potential to leverage ... Contract Manager collects and conducts analysis of spend data and other utilization data to identify expense reduction and operational improvement opportunities as… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** + **Three years of… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** + **Three years of… more
- HCA Healthcare (Tallahassee, FL)
- …and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party ... is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review, preferred** + **Three years of… more
- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …Microsoft and a web-based application for daily entry of case activity and the utilization management of service authorizations. 3. 2+ years of Team Facilitation ... Position Summary: This position oversees and manages the authorization and utilization of services delivered for families determined by the Department of… more
- Community Based Care of Brevard, Inc. (Rockledge, FL)
- …and a web based application for daily entry of case activity and the utilization management of service authorizations. 2+ years' experience serving at risk ... case plan outlining family needs, goals and services. Service Utilization UM/Wrap: This is strongly recommended in order to...in order to manage and track the daily service utilization log, monitors costs and tracks 3rd party resources.… 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 ... clinical guidelines. + Provides support and review of medical claims and utilization practices.. **Responsibilities:** + May provide any of the following in support… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for all Medicare Part D formulary creation and submissions, which includes utilization management criteria development for the current and upcoming contract ... enrollees. + Creates and operationalizes Medicare Part D criteria for all utilization management requirements in alignment with the Utilization Management… more