- Sharp HealthCare (San Diego, CA)
- …and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective rev1ew ... process. + Participates in risk management , pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting, site visit … more
- Centene Corporation (Tallahassee, FL)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Tallahassee, FL)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Virginia Mason Franciscan Health (Tacoma, WA)
- …of the medical staff and take on the role as leader of the Hospital's utilization review / management committee, which is charged with adhering to regulatory ... RAC entities, or other agents as required * Participate in the utilization review / management committee, in defining operational strategic objectives for the … more
- AdventHealth (Orlando, FL)
- …Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive ... care providers). Works in close coordination with the processes of the Utilization Review Management staff for continual process improvement and reporting.… more
- Corewell Health (Royal Oak, MI)
- …discharge planning of all hospitalized patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... years of relevant experience Three to five years' experience in care management , utilization review , home care and/or discharge planning. Preferred +… more
- Corewell Health (Dearborn, MI)
- …discharge planning of all hospitalized patients. + Identifies patients that need care management services (ie utilization review ; care coordination; and/or ... years of relevant experience Three to five years' experience in care management , utilization review , home care and/or discharge planning. Preferred +… more
- Baylor Scott & White Health (Temple, TX)
- …health services policies, methodologies, procedures, criteria, and guidelines to ensure effective utilization review and management that delivers appropriate ... vendor or contractor management that perform some of the utilization review functions on behalf of the healthplan. Coordinates with medical, clinical, and… more
- Houston Methodist (Sugar Land, TX)
- …Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Sharp HealthCare (San Diego, CA)
- …visits and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective ... + Participates in risk management reviews. + Assists in pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting,… more