- Healthfirst (NY)
- …Medical Peer Reviewer will:** + **Maintain productivity standards.** + **Collaborate with Utilization Management and Care Management and medical departments ... in Internal Medicine or Family Practice** + **Previous, relevant experience in utilization management and clinical practice** + **Knowledge of Medicare,… more
- Sevita (San Diego, CA)
- …to manage census, maintain occupancy, improve daily attendance and/or maximize utilization . **Financial Management ** 1. Purchasing: When applicable, approves ... responsible for the operation of the program including case management , Mentor recruitment, advocacy, stakeholder relations, regulatory compliance, staffing,… more
- Humana (Richmond, VA)
- …speaking engagements annually. + Providing guidance to Group Medicare customers on Utilization Management processes and CMS guidance and collaborating with the ... performance, risk adjustment, and stars. This CMO frequently interacts with the senior management team when representing Group MA with the Group MA SVP. In this… more
- Stony Brook University (Stony Brook, NY)
- …telephonically post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care ... is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization... management plans such as clinical needs, barriers, utilization of resources via assessments and/or progress notes. *… more
- HCA Healthcare (Englewood, CO)
- …patient through the continuum of care, including discharge planning. Oversee utilization management process including verification of insurance coverage, ... and family needs with the efficacious and cost effective utilization of resources. Coordinates patient, family, physicians and all...pre-authorization, resource management and overall management of patients within… more
- Highmark Health (Wexford, PA)
- …referral screening/ management . **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management : Reviews pharmacy utilization management ... ensuring timely patient access to necessary services. (30%) + Data Management & Compliance: Responsible for all preauthorization entries into applicable databases… more
- CVS Health (Hartford, CT)
- …basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and ... Medicare policy and appeals to the appeal nurses and territory Utilization Management Staff * Participate in ongoing initiatives to improve appeals team… more
- Veterans Affairs, Veterans Health Administration (St. Cloud, MN)
- …to improve processes to meet the performance measure goals and improve utilization management . Reviews requests for contracts including the Medical Officer ... the service. Plans, coordinates, and ensures high quality care through utilization of multiple quality measurement tools. Education Encourages and supports education… more
- Elevance Health (Indianapolis, IN)
- …test requests. + Works closely with senior reviewers/leaders on complex cases for utilization management , out of network and appropriateness of treatment. + ... **Genetic Counselor Review Associate** **Genetic Testing Utilization Review** **Carelon Medical Benefits Management ** **Virtual** : This role enables associates… more
- St. Luke's University Health Network (Phillipsburg, NJ)
- …, including but not limited to: Social workers, assistants, coordinators, utilization management staff, and director. + Facilitates communication among ... The RN Care Manager coordinates the overall progression of care, resource utilization , and discharge planning for designated patient populations across the continuum… more