- 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
- UPMC (Washington, PA)
- …work on all the inpatient units. + Five years of experience in clinical, utilization management , home care, discharge planning, and/or case management ... we want to hear from you!_ Responsibilities: * Provide case management according to program descriptions including member/patient education, follow up on… 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
- Elevance Health (NC)
- …to get an OH License or a NC License_** + Previous experience in case management / utilization management with a broad range of experience with complex ... abuse cases preferred. + Bilingual in Spanish is highly preferred + Utilization Management experience is preferred + Previous crisis hotline is… more
- 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
- 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
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