- ChenMed (Miami, FL)
- …our team. The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Technician (RBT) or Registered Line Technician (RLT) + Experience supporting utilization management processes or working with Electronic Health Records/Systems ... initiates authorization workflows, and appropriately routes cases to the BCBA Utilization Reviewer. + Communicates authorization decisions and procedural guidance to… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the appropriate… more
- HCA Healthcare (Nashville, TN)
- …required (LPC, LMFT, LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with required DSM V-R ... is reimbursed by contacting managed care organizations and completing initial utilization review. Documents in Midas as required. Involves mobile crisis when… more
- LA Care Health Plan (Los Angeles, CA)
- …Functional knowledge of HEDIS, HIE, Health Analytics required. Functional knowledge of Utilization Management , Care Management , Clinical Case Management ... (eg Clinical Care Advance, ZeOmega, Altruista, Thrasys) required. Functional knowledge of Utilization Management , Care Management , Clinical Case … more
- Cardinal Health (Tewksbury, MA)
- …DCOA as an objective tool to work with specific Medical Staff Departments or Utilization Management Teams to improve medication utilization + Ensures ... System Director of Pharmacy (HSD), Director of Pharmacy Operations and Account Management , and Cardinal Health Clinical Director, the Health System Clinical Director… more
- Molina Healthcare (WA)
- …care or medical or behavioral health settings. Prior experience in Utilization Management and discharge planning. **Preferred License, Certification, ... Association** Active, unrestricted Certified Case Manager (CCM) Some experience with Utilization Management processes is desirable (InterQual, MCG guidelines) ,… more
- The Cigna Group (Bloomfield, CT)
- …external customers. He/she will serve as a clinical educator and consultant to utilization management , case management , network, contracting, pharmacy, and ... in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a managed care setting.… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more
- CDPHP (Latham, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… more