- Trinity Health (Grand Rapids, MI)
- …in terms of quality, safety, service, affordability, and technology. Oversees drug utilization management efforts; manages the pharmaceutical supply chain; and ... including new services/programs, revenue enhancement, expense reduction, managed care utilization systems, and strategies. Responsible for ensuring performance excellence… more
- Molina Healthcare (Fort Worth, TX)
- …position we are seeking a TX licensed Occupational Therapist to join the utilization management team conducting reviews for cases requiring OT services. ... teams to promote the Molina care model. * Adheres to applicable utilization management policies and procedures. Required Qualifications * At least… more
- Elevance Health (Houston, TX)
- …Behavioral Health Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists ... staff and external Behavioral Health Providers to ensure appropriate and consistent utilization of plan benefits, out of network services, and clinical guidelines… more
- Catholic Health Initiatives (Little Rock, AR)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria. +… more
- CommonSpirit Health (Rancho Cordova, CA)
- …leading up to or including supervisory role highly preferred + Experience in Utilization Management , Case Management or Care Coordination, Managed Care ... assessment to prioritize patient transfers based on urgency of patient's condition, utilization of available beds. + Communicate effectively with hospital staff to… more
- Essentia Health (Fargo, ND)
- …timely and accurate information to payers. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. This ... to meet patient needs, manage length of stay, and promote efficient utilization of resources for a designated caseload. **Education Qualifications:** This position… more
- Highmark Health (Buffalo, NY)
- …the requested authorization. **ESSENTIAL RESPONSIBILITIES** + Obtain call task from Utilization Management platform, perform verbal outbound call task ... appropriately log result within the platform. + Obtain triage task from Utilization Management platform and follow a detailed desk level procedure to enter the… more
- Veterans Affairs, Veterans Health Administration (Florence, KY)
- …medical students, social work interns/staff, physician assistant and nursing students, Utilization management personnel, and Internal Medicine staff). Duties ... in impacting InterQual appropriate outpatient admissions / observation status utilization performance measures. Responsible for outpatient care, and graduate and… more
- Amergis (Orange, CA)
- …to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management ) will be responsible for reviewing and processing requests for ... as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + Behavioral… more
- Covenant Health Inc. (Louisville, TN)
- …level of care decisions as needed. + Coordinates as necessary to ensure that utilization management occurs and that clients are receiving services at the ... specialists within and outside the Covenant system to facilitate awareness and utilization of services. + Demonstrates knowledge and competency in providing for the… more