- Prime Therapeutics (Trenton, NJ)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... cost solutions that meet the desired outcomes of the customer; general management of the account, including P&L responsibility; and accountability for contract… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- CenterWell (Carson City, NV)
- …planning, determining services, providers, and expected outcomes collaboratively. *Focus on utilization management and review provider schedules to meet patient ... initiatives, including Quality, HEDIS/STARs, AHCA, optimal patient scheduling, financial management , patient engagement, recruiting/hiring, and employee and patient retention.… more
- Katmai (Usaf Academy, CO)
- …with military and civilian healthcare providers and staff and uses Utilization Management (UM) systems support to identify high-risk/high-cost patients ... **SUMMARY:** Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions. **ESSENTIAL DUTIES &… more
- CVS Health (Springfield, IL)
- …CM, discharge planning and/or home health care coordination experience + Previous Utilization Management experience, transitions of care and discharge planning ... members. Community Care is a member centric, team-delivered, community-based care management model that joins members where they are. With compassionate attention… more
- ERP International (Macdill AFB, FL)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... International is seeking **Registered** **Nurse (RN)** for Full-Time positions in **Case Management ** at MacDill AFB, FL. Apply online today and discover more about… more
- Commonwealth Care Alliance (Boston, MA)
- …and provider relationship management tools. * Understanding of claims operations, utilization management , and quality programs as they relate to provider ... engagement, delegation partnerships, provider services, contracting, quality, compliance, medical management , and analytics teams to advance provider network operations,… more
- US Tech Solutions (Topeka, KS)
- …for Healthcare. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by… more
- ERP International (Tinker AFB, OK)
- …algorithms, CM software, and databases for community resources. * Integrate CM and utilization management (UM) and integrating nursing case management with ... sectors. We provide comprehensive enterprise information technology, strategic sourcing, and management solutions to DoD and federal civilian agencies in 40 states.… more
- CenterWell (Seneca, SC)
- …opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per ... early detection. The PL is responsible for executing the clinical strategy through the management of their own patient panel as well as those of the clinicians whom… more