- Elevance Health (NC)
- …supervision. **Preferred Skills, Capabilities and Experiences:** + Previous experience in case management / utilization management with a broad range of ... experience with complex psychiatric/substance abuse cases preferred + Bilingual in Spanish is highly preferred _For URAC accredited areas, the following professional competencies apply: Associates in this role are expected to have strong oral, written and… more
- Bluestone Physician Services (Detroit Lakes, MN)
- …medical care teams to ensure health care quality measures are met and use utilization management tools to meet value-based goals + Supporting members during ... more years of experience working with the geriatric population in case management /care coordination, Home Care, Nursing Home, TCU or Assisted Living settings… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more
- State of Minnesota (Brainerd, MN)
- …clinical capacity. + Provide clinical input on program design, admissions, discharges, utilization management , clinical policies, and procedures. + This position ... and developing community engagement skills, as well as increasing independence and self- management of their illness, behavior, and emotion. **Job duties include:** +… more
- CVS Health (Phoenix, AZ)
- …appreciate the significance of formulary establishment and understand the various utilization management tools used in administering pharmacy benefits. ... of this program is to prepare medical residents with a comprehensive understanding of pharmacy benefit management . By the end of the program, participants will… more
- CVS Health (Hartford, CT)
- …in state of residence **Preferred Qualifications** Managed Care experience Utilization Management experience Appeals experience Pre Certification experience ... all colleagues** including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching. + **Benefit… more
- Wolters Kluwer (Riverwoods, IL)
- …to retain and grow existing commercial customer base + Review account utilization management reporting and provide recommendations + Conduct regular account ... The Sr. Strategic Account & Relationship Management Executive will be responsible for managing and growing existing Commercial Customer relationships in a defined,… more
- UPMC (Pittsburgh, PA)
- …establish patients' plans of care in collaboration with physicians, patients, and utilization management (UM) professionals to meet physicians' orders and ... patients' needs. + RN will coordinate case management activities across a multi-disciplinary health care team to ensure appropriate, quality patient care. +… more
- LA Care Health Plan (Los Angeles, CA)
- …multi-departmental (Member Services, Product Network Operations (PNO), Claims, Utilization Management (UM), Pharmacy, Medicare Enrollment/Disenrollment, Sales ... and Quality Management (QM)) processes to ensure identification of member's claims of gaps in coverage and resolution of cases for members' satisfaction and of referral cases to plan partners when applicable. The Navigator will be stationed and available… more
- Queen's Health System (Honolulu, HI)
- …to, initiation and development of the plan of care, patient/family education, utilization management and discharge planning. II. TYPICAL PHYSICAL DEMANDS ... and Family Treatment Center includes occasionally accompanying patients outdoors. Management of confused/disoriented and combative patients may involve tasks which… more