- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Centene Corporation (Raleigh, NC)
- …the American Osteopathic Association's Department of Certifying Board Services + Utilization Management experience and knowledge of quality accreditation ... the business unit. + Provides medical insights and/or interpretation for utilization management , cost containment, and medical quality improvement activities.… more
- Community Health Systems (Gadsden, AL)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... Part-Time role **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities… more
- Beth Israel Lahey Health (Plymouth, MA)
- …stay, 3) Decreasing unit cost, 4) reducing readmissions. **Duties/Responsibilities:** **A. Utilization Management ** Performs review of anticipated admissions ... status. This role is structured around four major functions + Utilization Management + Care Coordination + Discharge Planning + Preventing Unnecessary… more
- Community Health Systems (Bentonville, AR)
- …**Qualifications** + 2-4 years of clinical nursing experience required + Experience in utilization review , case management , or discharge planning preferred ... place to live! **Job Summary** The Care Manager - LPN supports effective utilization management and discharge planning by coordinating patient care activities… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management , cost containment, and medical quality improvement activities. ... Performs medical review activities pertaining to utilization review...expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory,… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems....departments, and others whose support is necessary for the management and success for the program. . Serves as… more
- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- AdventHealth (Orlando, FL)
- …appeals for denials. Provides guidance to clinical questions from Utilization Management staff involved in authorizations, concurrent review , and denials as ... and serves as a resource to Medical Staff colleagues regarding best practices, Utilization Management and Care Management structures, and functions and… more