- Humana (Oklahoma City, OK)
- …+ Previous Medicare/Medicaid experience a plus + Previous experience in pre-authorization, utilization management , case management , discharge planning and/or ... telephonic calls averaging 50% communication with providers + Educates providers on utilization and medical management processes + Enters and maintains pertinent… more
- Calvary Hospital (Bronx, NY)
- …Flex Spending, Transit Check. + Free On-Site Parking Requirements Participates in the Utilization Review , Discharge Planning, Risk Management , and Quality ... NYS licensure. + Five (5) or more years experience in either Utilization Management , Quality Assessment and Improvement, Risk Management , and/or Discharge… more
- Highmark Health (Pittsburgh, PA)
- …referral screening/ management . **ESSENTIAL RESPONSIBILITIES** + Prior Authorization & Utilization Management : Reviews pharmacy utilization management ... for both pharmacy and medical benefits and prepares such cases for clinical review when required. Within the context of the request, applies plan-specific benefits… more
- HCA Healthcare (Englewood, CO)
- …patient through the continuum of care, including discharge planning. Oversee utilization management process including verification of insurance coverage, ... and family needs with the efficacious and cost effective utilization of resources. Coordinates patient, family, physicians and all...pre-authorization, resource management and overall management of patients within… more
- CVS Health (Hartford, CT)
- …basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and ... appeal nurses; supervision and participation in the Second Look Review (SLR) process * Provide direct support to the...policy and appeals to the appeal nurses and territory Utilization Management Staff * Participate in ongoing… more
- UCLA Health (Los Angeles, CA)
- …care experience post residency, required + Minimum of 2 years of experience in Utilization Management + 2 or more years of experience working managed care ... team on safe, effective medication use; participate in drug review rounds and P&T Committee. + Contribute to interdisciplinary...+ Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case … more
- HCA Healthcare (Cypress, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge,… more
- Humana (Jefferson City, MO)
- …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
- Catholic Health Initiatives (Lisbon, ND)
- …+ 3-5 year's current clinical experience in acute care settings + Prior Case Management / Utilization Review **Where You'll Work** CHI Lisbon Health is a ... **Job Summary and Responsibilities** As a Case Management Professional, you will be a pivotal coordinator...planning team. + Documents discharge planning as an ongoing review . + Monitors and coordinates swing bed referrals. +… more
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