- BJC HealthCare (St. Louis, MO)
- …of Patient Care Services. The CM Service is comprised of three departments: Case Management , Utilization Management , and Social Work. Through the Triad Model ... to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to… more
- Regeneron Pharmaceuticals (Columbus, OH)
- …highly challenging for HCPs and Patients. Payer Formularies and restrictive Utilization Management Criteria including Prior Authorization Processes, Step Edits, ... on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for assigned products + Establish relationships… more
- Sharecare (Albany, NY)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex pharmacy inquiries + Complex spending… more
- Truman Medical Centers (Kansas City, MO)
- …English, both spoken and written **Preferred Qualifications:** + RN experience in hospital utilization review, utilization management , or case management ... you will identify patients who would benefit from case management services and coordinate care across the continuum by...+ Assess patient needs and determine eligibility for case management services + Collaborate with patients, families, and the… more
- Prime Healthcare (Evanston, IL)
- …+ Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Plan. #LI-AG5 Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… more
- State of Connecticut, Department of Administrative Services (Torrington, CT)
- …and/or behavioral health initiatives. + Experience with reviewing budgets and utilization management strategies. + Experience with developing and implementing ... direction to perform their responsibilities. + Actively participate in monthly Labor Management meetings and hold regular meetings with delegates to address issues… more
- Calvary Hospital (Bronx, NY)
- …Calvary Hospital. Qualifications: + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , ... identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review, Discharge Planning, Risk Management , and Quality Assessment and… more
- Centene Corporation (Bedford, NH)
- …abuse across the continuum of care required + Experience with managed care, case management , utilization management , or quality improvement required + For ... member satisfaction + Serve as resource and liaison on utilization , quality improvement and case management activities...liaison on utilization , quality improvement and case management activities + For NH Health Plan Only: Perform… more
- Humana (Lincoln, NE)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , or similar activities **Preferred ... industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical management… more
- St. Luke's University Health Network (Allentown, PA)
- …in order to facilitate a positive outcome for patients. + Assists in the utilization management of psychiatric patients. + Maintains clinical records of all ... + Provides case management duties as assigned by Supervisor. Case Management duties include individual assessments, utilization reviews, family or support… more