- Elevance Health (Tampa, FL)
- …Prepares reports and documents all actions. + Responsibilities exclude conducting any utilization management review activities which require interpretation ... appropriate area to refer or assign case ( utilization management , case management , QI, Med Review ). Provides information regarding network providers… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …true colors to blue. The Role:The Compliance Program Consultant will focus on utilization management compliance and audit readiness activities such as evaluating ... Medical Management 's (HMM) and delegate's compliance with the applicable NCQA utilization management standards and state and federal regulations. The Team:… more
- BeOne Medicines (San Mateo, CA)
- …Resource Management will lead the end-to-end global budget & resource management / utilization within GCO including the development of the Annual Operating ... team on resource-related decisions, including prioritization, hiring, and FSP vendor utilization . + Lead cross-functional resource review forums to optimize… more
- Highmark Health (Tallahassee, FL)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... and DOL regulations at all times. In addition to utilization review , the incumbent participates as the...member of the multidisciplinary team for case and disease management . They will advise the multidisciplinary team on cases,… more
- Tenet Healthcare (Detroit, MI)
- …coverage, and appropriate provider. Performs input into various databases as appropriate for utilization management , LOS management and Denial Management ... Care Management Tech - 2506004272 Description : DMC Sinai-Grace...and general concerns regarding policies and procedures. Maintains necessary utilization review files for all patients in… more
- Community Health Systems (Naples, FL)
- …Management is responsible for the planning, coordination, and oversight of care management services, including utilization review , discharge planning, and ... efficiently, effectively, and in compliance with organizational standards. + Oversees utilization review and discharge planning processes to ensure… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of ... review determinations. + Provides input into the utilization management program policies and procedures. +...Qualifications) + Minimum 2-3 years of experience in medical management , utilization review and case… more
- Aspirus Ironwood Hospital (Wausau, WI)
- …Coordination is responsible for system-wide Care Coordination functions ( Utilization Review , Social Work, Navigation, and Case Management ) including the ... management is required. + A minimum of five years of experience in care management or utilization review + A minimum of five to seven years of leadership… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... policies and procedures to determine clinical appropriateness. * Completes review of both medical documentation and claims data to...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more