- 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
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management , care transition, collaboration with physicians ... years of inpatient experience in a hospital environment preferred. + Previous case management , utilization review , and discharge planning experience highly… 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
- 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
- Nuvance Health (Danbury, CT)
- …comprehensive, patient-centric vision and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge ... setting * Minimum of 5 years of progressive leadership experience in case management or utilization review * Proven leadership experience with a track record… 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
- Centene Corporation (Denver, CO)
- …and provide recommendations to senior management of process improvements within utilization management + Manages and oversees cases to ensure timely ... training and education to the interdepartmental teams on training needed within the utilization management team based on trends + Partners with leadership to… more
- Elevance Health (Tampa, FL)
- …Healthsun Plans, Freedom Health, and Optimum Healthcare Plans and will be responsible for utilization review case management for these markets. May be ... a State agency. **Preferred Qualifications:** + Bilingual- Spanish speaking preferred. + Utilization Management case review experience strongly preferred. +… more
- Ventura County (Ventura, CA)
- …evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards ... The ideal candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of… more
- Centene Corporation (Jefferson City, MO)
- …are seeking candidates with strong experience in payment integrity and utilization review .** **Education/Experience:** Requires Graduate from an Accredited ... knowledge of Medicare and Medicaid regulations preferred. Strong knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more