- Centene Corporation (Bedford, NH)
- …abuse across the continuum of care required + Experience with managed care, case management , utilization management , or quality improvement required + For ... groups and providers regarding clinical information from the Operations and Medical Management teams. Assesses and performs review of member clinical records… more
- Humana (Lincoln, NE)
- …management + Utilization management experience in a medical management review organization such as Medicare Advantage, managed Medicaid, or Commercial ... The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D & B). The...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- UPMC (Pittsburgh, PA)
- …evidence on medical interventions, as well as coverage policies and utilization management standards of national insurers, accountable care organizations, ... report results. + BSN required. Advanced degree is preferred. + Prior experience with utilization management and/or case management is strongly preferred. +… more
- Truman Medical Centers (Kansas City, MO)
- …in English, both spoken and written **Preferred Qualifications:** + RN experience in hospital utilization review , utilization management , or case ... you will identify patients who would benefit from case management services and coordinate care across the continuum by...+ Assess patient needs and determine eligibility for case management services + Collaborate with patients, families, and the… more
- Calvary Hospital (Bronx, NY)
- …and identify the expected length of stay (ELOS). The RNCM participates in the Utilization Review , Discharge Planning, Risk Management , and Quality Assessment ... Qualifications: + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
- St. Luke's University Health Network (Allentown, PA)
- …in order to facilitate a positive outcome for patients. + Assists in the utilization management of psychiatric patients. + Maintains clinical records of all ... + Provides case management duties as assigned by Supervisor. Case Management duties include individual assessments, utilization reviews, family or support… more
- Stony Brook University (Stony Brook, NY)
- …telephonically post-discharge and assist with barriers to care * Prior experience with Care Management or Utilization Management * Understand levels of care ... is provided to the patients. * Documents the case management plans such as clinical needs, barriers, utilization...or for a maximum of 90 days. An initial review of all applicants will occur two weeks from… more
- East Boston Neighborhood Health Center (Revere, MA)
- …as it relates to timely and accurate claims payment and improvements to utilization management . + Responsible for maintaining up-to-date knowledge of fee ... . Time Type: Full time Department: PACE Health Plan Management All Locations: 300 Ocean Avenue - Revere Position...Coordinating with the Manager of PACE Claims to proactively review referrals and claims-related data in an effort to… more
- Penn Medicine (Plainsboro, NJ)
- …timely and accurate information to payors. The role integrates and coordinates utilization management , care facilitation and discharge planning functions. In ... the multi-disciplinary care team to effect timely, appropriate patient management .Addresses/resolves system problems impeding diagnostic or treatment progress. Proactively… more
- Catholic Health Services (West Islip, NY)
- …CH HAC Meeting, Hospital Performance Improvement and Patient Safety Committee, and Utilization Management Committee. + Participate in the development and ... in and serve as a physician resource for Risk Management activities and processes, such as Root Cause Analyses,...activities and processes, such as Root Cause Analyses, to review and monitor the quality of care provided to… more