- 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
- 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
- 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
- Houston Methodist (The Woodlands, TX)
- …state, local and federal programs + Comprehensive knowledge of discharge planning, utilization management , case management , performance improvement and ... Manager (CM) Certified position is responsible for comprehensively planning for case management which includes care transitions and discharge planning of a targeted… more
- Magellan Health Services (Albuquerque, NM)
- …the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care ... and on-going management of designated staff. + Performs care management review activities consistent with Magellan policies, procedures, and standards.… more
- CVS Health (Topeka, KS)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... training.** American Health Holding, Inc (AHH) is a medical management company that is a division within Aetna/CVS Health....lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Austin, TX)
- …candidates in compact RN states. This role is a blended role doing both Case Management and Utilization Management . The RN Case Manager is responsible for ... - Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit...practice experience as an RN - 6+ months Case Management or Utilization Management experience… more
- The Cigna Group (Bloomfield, CT)
- …management functions, including case management (CM), utilization management (UM), and escalated case review . Ensures policies, procedures, and ... operating within health plan environments, including fluency in medical management functions such as utilization management (UM), case management (CM),… more
- Centene Corporation (New York, NY)
- …preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Actalent (Baton Rouge, LA)
- …service. + Knowledge of Medicare and Medicaid regulations. + Familiarity with utilization management processes. Additional Skills & Qualifications + Experience ... + Work with healthcare providers and the authorization team to ensure timely review of services and requests, ensuring members receive authorized care. + Coordinate… more