- Independent Health (Buffalo, NY)
- …credentials preferred. + Four (4) years of clinical experience required. Utilization Management experience preferred. + Comprehensive knowledge and experience ... The Clinical Reviewer will be responsible for the collection and review of medical records specific to quality complaints/grievances and appeals as indicated in… more
- CommonSpirit Health (Englewood, CO)
- **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... to all constituents.** **Key Responsibilities** + Conducts medical record review in appropriate cases for medical necessity of inpatient...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
- Centene Corporation (Indianapolis, IN)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… more
- Intermountain Health (Provo, UT)
- …The Manager of Care Management II leads and collaborates with care management operations across utilization review , acute and emergency department care, ... **Preferred Qualifications** + Management experience in hospital Care Management , utilization review , ambulatory care management , ambulatory … more
- Alameda Health System (Oakland, CA)
- …3 years, experience in Case Management in an acute setting or utilization review at a medical group or health plan. Required Licenses/Certifications: Active ... Management provides Care Coordination, Compliance, Transition Coordination, and Utilization Management . **DUTIES & ESSENTIAL JOB FUNCTIONS** NOTE:The… more
- Children's Mercy Kansas City (Kansas City, MO)
- …development of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Sharp HealthCare (San Diego, CA)
- …and responds to accrediting and regulatory agency feedback. + Supports pre-admission review , utilization management , and concurrent and retrospective rev1ew ... process. + Participates in risk management , pharmacy utilization management , catastrophic case review , outreach programs, HEDIS reporting, site visit … more
- Centene Corporation (Tallahassee, FL)
- …Interact with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
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