- CVS Health (Phoenix, AZ)
- …team maintains compliance and privacy practices. + Oversee the implementation of utilization management services for assigned area. + Implement clinical policies ... key business areas. + May develop/assist in development and review new training content. + May collaborate/deliver inter and...Registered Nurse (RN). + 2+ years of experience in utilization management . + Active, current, and unrestricted… more
- Veterans Affairs, Veterans Health Administration (Battle Creek, MI)
- …other champions to improve processes to meet the performance measure goals and improve utilization management ; serving as a liaison to outside facilities when to ... Serves as a Mental Health leader for quality improvement initiatives and utilization management related to Psychiatry Service. Plans, coordinates and ensures… more
- ChenMed (Miami Gardens, FL)
- …day-to-day operations and strategic decisions. + Leads and develops projects focused on utilization management trends which help find insights in the data and ... quality, design, and implementation. This position aligns and oversees the management , development, and integration of data analytics and business intelligence… more
- Nuvance Health (Poughkeepsie, NY)
- …in Nursing, BSN preferred. Must have current RN license. *Preferred Experience: * Utilization Review / Management .Company: Vassar Brothers Medical Center Org ... case from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within… more
- Dignity Health (Long Beach, CA)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. + Able to...multiple stakeholders + Professional communication skills. + Understand how utilization management and case management … more
- Kaleida Health (Buffalo, NY)
- …and tactics to successfully execute, support, implement, and monitor the DRG and Utilization Management Clinical Denial teams Work Plan and, assists in the ... coding conventions and insurance / managed care practices including but not limited to: utilization review , RAC, MAC, Q10, clinical and DRG denial management … more
- HCA Healthcare (Sanford, FL)
- …in Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida Lake Monroe ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4… more
- CVS Health (Phoenix, AZ)
- …plan medical directors. + Attends and participates in clinical meetings with care management and utilization management . Provides subject matter expertise on ... the direction of the Lead Director, Service Operations, this position will focus on utilization , quality and fraud waste and abuse review for individual cases… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role BHPS provides Utilization Management (UM) services to its clients, ensuring high-quality, clinically sound decision-making. The Clinical Appeal ... accurate decisions + Ensure strict adherence to Appeals and Utilization Management (UM) processes and regulatory and...URAC, NCQA, and ERISA + Proficiency in Clinical Appeals, Utilization Review , and Grievance processes including benefit… more
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