- CommonSpirit Health (Phoenix, AZ)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... assessment to prioritize patient transfers based on urgency of patient's condition, utilization of available beds. + Communicate effectively with hospital staff to… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …skills + Appreciate continuous program improvement **Job Responsibilities** + Supporting utilization management functions for more complex and non\-routine cases ... mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits + Performing the essential activities of case … more
- Genesis Healthcare (FL)
- …outcomes including, but not limited to: financial performance, risk adjustment, utilization management , quality performance, clinical performance, etc. 7. Shares ... tracks, monitors and reports on key program attribution, financial, utilization , clinical, and quality performance metrics within assigned groups/geographies.… more
- Banner Health (Mesa, AZ)
- …both internal and external customers. Manages data as related to operations. Performs Utilization Management functions as required by facility CORE FUNCTIONS 1. ... problems and information to appropriate Nursing leadership. Prioritizes safe utilization of resources. 4. Creates and distributes individualized ad-hoc reports… more
- Veterans Affairs, Veterans Health Administration (Wichita, KS)
- …to improve processes to meet the performance measure goals and improve utilization management . Responsibilities Approval from your current supervisor will be ... champions to improve processes to meet the performance measure goals and improve utilization management . Reviews requests for contracts and helps determine the… more
- St. Luke's University Health Network (Quakertown, PA)
- …who may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and ... mental health/crisis intervention experience required. Previous experience with case management / utilization review and managed care models preferred. Please… more
- AnMed Health (Anderson, SC)
- …impact here. Summary Responsible for the resolution of disputes on escalated claims, utilization management , or other denials. Reviews any changes to health ... related field (required) 2-4 years experience in managed care, appeals, grievances, utilization management , or revenue cycle Proficiency in Microsoft Office… more
- US Tech Solutions (Canton, MA)
- …possible extension)** **Job Descriptions** + Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is responsible ... as a Prior Authorisation Pharmacist in a managed care setting + Utilization Management experience is required. **Education:** + Degree in Pharmacy or equivalent… more
- Bon Secours Mercy Health (Cincinnati, OH)
- …per test for both in-house and referral tests. + Develop and chair a utilization management review committee and partner with the prior authorization team. + ... thinking, and problem-solving skills. + Excellent communication, collaboration, and project management skills. + Proven ability to influence physician behavior and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross Blue Shield of MN! This role is a key contributor to our Utilization Management team, helping to shape smarter, data-driven decisions that improve how ... Experience * Bachelor's degree. * Experience with health care data (focus on Utilization Management a plus) * Experience with AWS tools * Experience with version… more