- Amergis (Orange, CA)
- …such as those listed above may also be qualifying. Preferred Qualifications: + Utilization management reviewer experience. + Managed care experience. + ... to help support a health insurance agency! The Medical Case Manager (BHI Utilization Management ) will be responsible for reviewing and processing requests for… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …of consistent and quality health care services. Examples may include: Utilization Management , Quality, Behavioral Health, Pharmacy, Registered Dietitian and ... within the group. + Responsible for all aspects of the Case Management department functions including quality, productivity, utilization performance, and… 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
- Magellan Health Services (Boise, ID)
- …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 (Denver, CO)
- …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
- ChenMed (Hampton, VA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The Case Manager ... professional nurse, RN, LPN, etc. + Minimum of seven (7) plus years of utilization review /case management . + Minimum of seven (7) plus years of experience in… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- Johns Hopkins University (Baltimore, MD)
- …plan functions such as claims processing, premium billing, encounter data, utilization management , risk adjustment, provider contracting, quality metrics, and ... assigned areas, including performing effective risk assessments and meeting with institutional management to support the development of the annual audit plan. +… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications** : + Knowledge and experience with ... (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 case management and utilization management , the… more
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- …the provision of dental services and utilization review ; + Periodically review Utilization Management data from the dental vendor and statistical ... + Hybrid schedule The Role: + Oversee the claim and prior authorization review processes, dental regulations and procedure adherence, management to address… more