- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The Medical Director oversees all activities of utilization review , care management and quality to determine the ... network physicians for peer-to-peer case discussion. + Provides clinical support for utilization review , care management and quality to determine the medical… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …nursing experience, including behavioral/mental health + Experience in a managed care, case management , or utilization review setting + Strong understanding ... + Participate in interdisciplinary case rounds, quality improvement initiatives, and utilization review processes. + Support members during transitions of… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- HCA Healthcare (Tallahassee, FL)
- …is acceptable for position if current and compliant** + **Certification in Case Management , Nursing, or Utilization Review , preferred** + **Three years ... and assess observation patients for appropriateness in observation status + Performs utilization management reviews and communicates information to third party… more
- Johns Hopkins University (Baltimore, MD)
- …leadership with special projects as needed, such as space assessments and utilization , crisis management and safety protocol. **Special Knowledge, Skills, and ... who will be responsible for assisting the Director of Capital Planning and Facilities Management with the overall daily management of the facility and its… more
- CVS Health (Phoenix, AZ)
- …utilizes skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. They apply critical thinking and knowledge in ... limited to):** + Evaluation of Members + Through the use of care management tools and information/data review , conducts comprehensive evaluation of referred… more
- HCA Healthcare (Kissimmee, FL)
- …monitor and improve the patient flow program effectiveness as it relates to utilization review , resource management , and discharge planning and care ... educational leader to physicians and employees as it relates to utilization review , resource management , patient flow, multi-disciplinary rounds and hospital… more
- Sutter Health (San Francisco, CA)
- …Med Center Davies **Position Overview:** Conducts preauthorization, concurrent, and retrospective utilization management review using the department's ... and at the appropriate level of care. Coordinates the utilization management , resource management , discharge...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- Corewell Health (Grand Rapids, MI)
- …of the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The ... peer to peer clinical discussions, and participation in denials management which include review of previous clinical...management + Provide clinical oversight to nurse case management and utilization management . +… more
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