- Mindoula Health (PA)
- …for outcome based care. + Participates in interdisciplinary team meetings and utilization management rounds and provides information to assist with safe ... transitions of care. + Promotes responsible and ethical stewardship of company resources. + Maintains excellent punctuality and attendance during work hours. Qualifications: + LCSW, LMFT, LPC, LMHC in Florida. + Preferred experience with substance abuse… more
- Mindoula Health (TN)
- …for outcome based care. + Participates in interdisciplinary team meetings and utilization management rounds and provides information to assist with safe ... transitions of care. + Promotes responsible and ethical stewardship of company resources. + Maintains excellent punctuality and attendance during work hours. Qualifications: + LCSW, LMFT, LMHC, in Washington State. + Preferred experience with substance abuse… more
- The Cigna Group (Raleigh, NC)
- …and model monitoring / maintenance using a broad range of medical, prescription drug, utilization management , and third-party data. In this role you will work ... closely with leadership, data scientists, business stakeholders and engineering partners to deliver robust well-documented deliverables that will enhance our competitive position in the marketplace. **Responsibilities** + Contribute to the development of… more
- Point32Health (Canton, MA)
- …(https://www.point32health.org/) . **Job Summary** Under the direction of the Pharmacy Utilization Management (UM) Supervisor, the Clinical Pharmacist is ... responsible for reviewing, processing and managing the daily caseload of pharmacy prior authorization (PA) requests for coverage determinations (CD), and exceptions. The Clinical Pharmacist ensures timely disposition of reviews for CD and exceptions by… more
- Stanford Health Care (Palo Alto, CA)
- …area. + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance. + Knowledge ... of evaluation and treatment methodologies as applied to routine patient care. + Knowledge of legal issues affecting the clinical practice. + Knowledge of pathologies and injuries which result in physical, cognitive, and other functional impairments. +… more
- Veterans Affairs, Veterans Health Administration (Jackson, MS)
- …medicine, etc). Serves as lead physician for quality improvement initiatives and utilization management . Continuously assesses and improves the processes of care ... delivery to enhance patient safety. Participates in strategic planning and policy development, translating national and network directives into local clinical practice and performance goals. Collaborates with other Medical Center leaders to develop initiatives… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …similar role or with population served Clinical supervision certification Quality or utilization management experience Former VA Trainee Reference: For more ... information on this qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. The actual grade at which an applicant may be selected for this vacancy is GS-12. Physical Requirements: Moderate lifting/carrying 15-45 pounds, reaching… more
- Stanford Health Care (Palo Alto, CA)
- …area + Knowledge of basic business aspects of position, such as utilization management , charging practices and regulatory practice compliance; + Knowledge ... of evaluation and treatment methodologies as applied to routine patient care + Knowledge of legal issues affecting the clinical practice + Knowledge of pathologies and injuries which result in physical, cognitive and other functional impairments + Knowledge of… more
- Elevance Health (Wallingford, CT)
- …Capabilities, and Experiences:** + Actuarial sciences background highly preferred. + Utilization Management experience preferred. + Medical economics, provider ... finance, healthcare analytics, and/or financial services highly preferred. + Comprehensive understanding of medical claims data. + Intermediate to Advanced expertise with SQL, SQL Server, Teradata, or equivalent strongly preferred. + Proven ability to design… more
- UPMC (Pittsburgh, PA)
- …coordination of benefits, complaints and grievance guidelines and prescription drug utilization management requirements. + Thorough knowledge in MS Office ... and PC skills required. + Organizational, analytical, interpersonal, and communication skills. + Ability to prioritize and perform multiple tasks while maintaining designated production and quality standards. + Staff is required to work scheduled overtime and… more
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