- 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
- 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
- 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
- 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
- CVS Health (Phoenix, AZ)
- …+ Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Evaluation of Members; Through the use of ... care management tools and information/data review , conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case… 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
- 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
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