- Catholic Health Initiatives (Lexington, KY)
- …emphasis will be on care coordination, communication and collaboration with utilization management , nursing, physicians, ancillary departments, insurers and post ... their practice. 13. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** **Required...hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year… more
- Prime Healthcare (Evanston, IL)
- …+ Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Plan. #LI-AG5 Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… more
- CVS Health (Tallahassee, FL)
- …outcomes. * Leverage extensive knowledge of health care delivery system, utilization management , reimbursement methods and treatment protocols for DSNP/MMP ... Behavioral Health, Pharmacy, Member Outreach, Care Management , National Quality Management , Utilization Management , Compliance, and other departments to… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Coordination Specialist provides administrative support for any of the programs of Utilization Management , Behavioral Health, Quality Management , or Member ... and review timeliness, workflow volumes, referrals generated to care management programs + Provides administrative support to the grievance and appeals process… more
- Actalent (San Antonio, TX)
- …appropriate setting of care. Qualifications: + 4+ years experience in utilization management and utilization review /managed care/hospital setting as an ... "Urgent Hiring for " Utilization Review RN" Job Description: + Perform concurrent reviews to assess member's overall health. + Review the type of care being… more
- HCA Healthcare (Nashville, TN)
- …treatment is reimbursed by contacting managed care organizations and completing initial utilization review . Documents in Midas as required. Involves mobile ... LCSW, LADAC) + Previous experience in Needs Assessment and Utilization Management strongly preferred. + Familiarity with...patients in regard to managed care organizations + Conducts utilization review for managed care cases in… more
- University of Southern California (Los Angeles, CA)
- …Degree Nursing + Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + ... populations. The role integrates the functions of complex case management , utilization management , quality ...the Case Manager overlap into inpatient duties including: Concurrent review of all patients to validate that the appropriate… more
- Intermountain Health (Butte, MT)
- …. + Provide leadership and expertise to ensure that medical quality improvement and utilization management programs are carried out in clinical areas through the ... + Develop, implement and monitor medical policies and procedures (including case /disease management , utilization management and clinical programs) as they… more
- Cardinal Health (Tewksbury, MA)
- …DCOA as an objective tool to work with specific Medical Staff Departments or Utilization Management Teams to improve medication utilization + Ensures ... System Director of Pharmacy (HSD), Director of Pharmacy Operations and Account Management , and Cardinal Health Clinical Director, the Health System Clinical Director… more
- Penn Medicine (Princeton, NJ)
- …of pre-certifications as well as coordination of utilization reviews with utilization management reviewer . Timely and accurate completion of UM ... plan development and coordination, referent relations, discharge planning, and case management with social service support systems, schools and other relevant… more
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