- Humana (Baton Rouge, LA)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... member service or customer service telephone experience + Experience with Utilization Review and/or Prior Authorization, preferably within a Managed Care/Insurance… more
- St. Bernard's Medical Center (Jonesboro, AR)
- …of care for patient admission. Assist with Patient Placement Center and Utilization Management to perform admission status appropriateness by collaborating with ... MD, Patient Placement Coordinator, and Utilization Review Coordinator. Complies with guidelines, institutional policies and procedures, and other information to… more
- Elevance Health (FL)
- …Qualifications:** + Internal Medicine, or Family Medicine specialties preferred. + Utilization Management or Appeals experience preferred. For candidates working ... must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US military… more
- WellSpan Health (Lewisburg, PA)
- …data analysis as required. + Develops and initiates educational programs regarding utilization management principles. + Attends meetings as required, and ... participates on committees as requested. **Qualifications** **Minimum Education:** + Bachelors Degree Must be degreed in social work or social welfare per PA Act 68 of 2008. Required **Work Experience:** + Less than 1 year Relevant experience. Required… more
- Children's Home Healthcare (Albuquerque, NM)
- …have excellent communication skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for patient visits + ... for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional Services.… more
- Veterans Affairs, Veterans Health Administration (Cheyenne, WY)
- …and improved: Access. Quality of Care, Customer Service/Patient Satisfaction, and Utilization Management /Efficiency of Care. Research problems that impact the ... of life cycle, or missing equipment. Oversight of Performance Improvement/Quality Assurance/ Utilization Review and evaluation to ensure that the four dimensions of… more
- Veterans Affairs, Veterans Health Administration (West Roxbury, MA)
- …lines to improve processes to meet performance measure goals and improve utilization management . Liaisons with other inpatient, outpatient rehabilitation care ... evaluation program (OPPE/FPPE), as well as for quality improvement and resource utilization purposes on an ongoing basis. Oversee the establishment of program… more
- Community Based Care of Brevard, Inc. (Orlando, FL)
- …and a web-based application for daily entry of case activity and the utilization management of service authorizations. 2+ years of Team Facilitation Skills ... to maximize resources and adhere to policies and procedures. Responsible for utilization and monitoring flexible funding and service coordination in order to meet… more
- Monte Nido (Eugene, OR)
- …continuous care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and ... of care + Communicate with insurance providers for **pre-certification and utilization review** + Collaborate on **discharge and aftercare planning** + Provide… more
- Highmark Health (Little Rock, AR)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... itemized bills, and claims data to assure appropriate level of payment and resource utilization . It is also used to identify issues which can be used for education… more