- CVS Health (Charleston, WV)
- …concurrent review, and appeal request. This position is primarily responsible for Utilization Management , including prior authorization and pre certification as ... - Prior UM experience working at Health Plan / Insurer or experience as a Physician Advisor or working for an Independent Review Organization a Plus **Preferred… more
- GE HealthCare (CA)
- …sales forecasts and shared volume targets. With your Cardiac PET Physician Outreach teammate, conduct regular business analyses of the local market-customers, ... to create awareness of Flyrcado. * Be a trusted advisor to Imaging Centers and Cardiologists by deepening your...impact the decision-making criteria to help increase awareness and utilization of Flyrcado. * Prioritize multiple projects and drive… more
- HCA Healthcare (Brentwood, TN)
- …triage care etc. 6. Contracts impacted by the emergency department. 7. On call physician panel reviews and proper utilization . 8. Supply chain optimization and ... that impact ED throughput 4. Supply, medication, and resource utilization 5. Appropriate assignment of patients being admitted to...core team directors. + Serves as a facilitator, technical advisor , and analyst to hospital management and… more
- GE HealthCare (NJ)
- …sales forecasts and shared volume targets. With your Cardiac PET Physician Outreach teammate, conduct regular business analyses of the local market-customers, ... to create awareness of Flycardo. + Be a trusted advisor to Imaging Centers and Cardiologists by deepening your...impact the decision-making criteria to help increase awareness and utilization of Flyrcado. + Prioritize multiple projects and drive… more
- Fresenius Medical Center (Memphis, TN)
- …departments and external customers; particularly in problem resolution. Acts as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. + ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more
- Banner Health (Scottsdale, AZ)
- …regulatory and compliance requirement. This position will serve as the primary advisor to the Banner Telehealth senior leadership on matters related to ... In addition, this position may be eligible for our Management Incentive Program as part of your Total Rewards...innovative solutions. Assumes a leadership role, in partnership with physician and facility leaders, in managing the quality of… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and manages denials for patient status and continued patient stays with Attending Physician , Physician Advisor , Inpatient Nurse Care Manager, and ... and high level of communication skills to ensure appropriate utilization of and reimbursement for resources from admission through...of hire + One of the following: American Case Management Certification or Certified Case Manager + Employees must… more
- Tidelands Health (Georgetown, SC)
- …+ Maintain expert knowledge of InterQual Level of Care criteria. + Escalates to physician advisor when unable to resolve issues with the attending physician ... achieve optimal outcomes by identifying alternatives as needed. + Documents all care management assessments and interventions. + Acts as a resource to ED staff and… more
- Veterans Affairs, Veterans Health Administration (Oneonta, NY)
- …team let huddles and weekly team meetings where patient care planning and management occur, except during staff shortages for coverage. Performs daily review of ... active/pending consults, physician encounters, EWL, Recall Reminder list, Return to Clinic...administrative reports and documents for supervisor and Clinic Practice Management leader, generates patient workload reports for validation and… more
- AmeriHealth Caritas (Washington, DC)
- …Overview:** Provide organizational leadership in the operational areas of care management , utilization review, appeals, quality improvement and related policy ... provided by in network and non-network providers + Utilizes a high-performing medical management system that adheres to the terms of contracts and all relevant… more