- Elevance Health (Overland Park, KS)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Koniag Government Services (Germantown, MD)
- …Services, LLC,** a Koniag Government Services company, is seeking a Lead Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our ... design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons. **Essential Functions, Responsibilities & Duties… more
- Highmark Health (Baton Rouge, LA)
- …timeframes and notification requirements are met. + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... Documents, processes and routes requests for services to the nurse reviewer and other departments based on documentation procedures, including review… more
- Molina Healthcare (Las Vegas, NV)
- …in the development and execution of the Plan's disease management , case management , utilization management , and care management programs. Oversees ... of care management programs, including such programs as Quality Improvement, Utilization Management , Care Management , Predictive Modeling, and Disease … more
- Blue KC (MO)
- …when making decisions that may not have universal agreement, particularly around utilization review activities. + Review individual member experiences ... clinical initiatives by providing direction to physicians and other providers, Provides utilization management for medical, surgical and pharmacy activity. +… more
- Sutter Health (Emeryville, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Some awareness of… more
- Sutter Health (Modesto, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness… more
- CVS Health (Oklahoma City, OK)
- …and timely discharge, appropriate follow-up care, and next steps. + Coordinate with the Utilization Management team to review medical and payer records to ... observation stay through a clinical assessment and medical record review . + Triage to determine appropriate follow-up care and...stay and identify any barriers to discharge. + Assist Utilization Management team with access to external… more
- Evolent (Sacramento, CA)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Tallahassee, FL)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more