- New York State Civil Service (Albany, NY)
- …Pharmacy polices, handling member and provider inquires and requests for coverage, Drug Utilization Review (DUR) Board support including review of the ... experience.Preferred Qualifications: Experience in managed care and/or pharmacy benefits management . Knowledge of pharmacy utilization management … 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
- Rochester Regional Health (Rochester, NY)
- …in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews ... efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other… more
- Mayo Clinic (Rochester, MN)
- …patient plan of care throughout the continuum of care by ensuring appropriate utilization management , care coordination, resource utilization , and clinical ... outcomes. The RN Case Manager provides leadership through education on case management / utilization management concepts, committee work, research, and… more
- Texas Health Resources (Plano, TX)
- …also providing quality medical care. 5. Support effective patient throughput, utilization management , and compliant documentation. MEDICAL STAFF GOVERNANCE: 1. ... Credentials Committee to coordinate medical staff credentialing including the review of credentials, delineation of clinical privileges, development of privileges,… 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
- Humana (Santa Fe, NM)
- …of program changes and outcomes. Responsibilities include: + Oversee the development, review , and maintenance of Utilization Management (UM) policies ... complexity ranging from moderate to substantial. The Policy Governance Lead for Utilization Management (UM) is responsible for overseeing the development,… more
- Ascension Health (Georgetown, TX)
- …setting (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to ... of physicians apply today! **Responsibilities:** Work in areas of utilization management and denial mitigation, including but...and denial mitigation, including but not limited to: + Review medical records of identified patients to assist with… 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
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