- UPMC (Pittsburgh, PA)
- …of health insurance experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... clinical and social history, current medications, geriatric syndromes, healthcare resource utilization , and case management interventions. Updates the plan of… more
- Fallon Health (Worcester, MA)
- …Registered Nurse in a clinical setting required. * 2 years' experience as a Utilization Management /Prior Authorization nurse in a managed care payer preferred. * ... necessity, benefit eligibility, and network contract status criteria to a physician reviewer for consideration, ensuring the timely review of the referred… more
- Highmark Health (Harrisburg, PA)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… 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
- Community Based Care of Brevard, Inc. (Brevard, FL)
- …Position Summary: This position is responsible for the clinical coordination, utilization management , and authorization of initial and ongoing services ... alternative funding sources whenever possible. The position facilitates Team Review Meetings and the utilization review...the most efficient and effective use of agency resources. Utilization Management - Essential Function: Ensure that… more
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... position is a licensed registered nurse (RN) who comprehensively plans for case management of a target patient population on a designated unit(s). This position… more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. * Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management * Serve as the primary relationship manager and point of contact… more
- Nuvance Health (Poughkeepsie, NY)
- …Team Leaders via program dashboard on quality and process measures.Participates in quarterly Utilization Review . 7.Prepares reports to DQS and Clinical Team as ... *Description* Summary: *Purpose: *The Quality Systems Reviewer assists in the implementation of the Agencyi? 1/2s Performance Improvement, Risk Management ,… more
- McLaren Health Care (Bay City, MI)
- …to D/C). 4. Identifies unsigned level of care (LOC) orders; communicates with utilization management nurse and obtains orders from providers. 5. Reviews current ... **Three years of acute hospital care experience** _Preferred:_ + Experience in utilization management /case management , critical care, or patient… more
- Provider Solutions & Development (Mission Hills, CA)
- …of medical group management experience required + Must have working knowledge of utilization management and review essential to operations management ... with, motivate, and assist medical staff leadership to adhere to utilization management , clinical documentation, and other legal/regulatory requirements +… more
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