- Actalent (Portland, OR)
- …understanding of medical necessity criteria + Familiarity with Medicaid regulations and utilization management processes + Ability to work independently while ... Job Title: Clinical Review Nurse - Prior Authorization Location: Remote (this...Document clinical decisions and maintain accurate records in health management systems + Educate providers and internal teams on… more
- Prime Healthcare (Evanston, IL)
- …+ Responsible for the coordination of the various activities of the Case Management Department including utilization management , social services and ... Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and… 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
- 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
- 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
- Sharp HealthCare (San Diego, CA)
- …determinations for those requests that meet medical necessity criteria, appropriate utilization management and Sharp Health Plan criteria.For requests that ... issues as and directs daily workload to achieve efficiency and maximize resource utilization as business needs require; Attends and participates in staff meetings or… 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
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… 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
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Knowledge and experience with MCG ... (RN) embedded at a partnering hospital will conduct concurrent review of inpatient level of care, managing the timely...of care. Utilizing experience and skills in both care management and utilization management , the… more
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