- CareFirst (Baltimore, MD)
- …Appeals and Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Fairview Health Services (Minneapolis, MN)
- …knowledge of utilization review and collaborates with the Utilization Management Specialists to insure the ongoing, comprehensive monitoring and ... in the treatment planning process. + Coordinates treatment planning and leads management of each case. + Coordinates/facilitates the development of treatment plan by… more
- University of Washington (Seattle, WA)
- …the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management ), ... communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
- Healthfirst (NY)
- …oversight and operational management for all utilization management functions, including prior authorization, concurrent review , and service requests ... efforts for audits, performance improvement plans, and corrective actions related to utilization management + Foster a culture of accountability, professional… more
- Elevance Health (Ashburn, VA)
- …preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. Please be ... necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer… more
- BJC HealthCare (St. Louis, MO)
- …through the grounds and connects to Millennium Park. Care Coordination consist of Case Management , Social Services and Utilization Review . The personnel in ... to identify and resolve issues. Performs and provides consultation regarding Utilization Management and Performance Improvement programs in order to… more
- Kaleida Health (Williamsville, NY)
- …plans/care paths are addressed and met. Serve as liaison to ancillary and utilization review services, serve as communication link between health team members. ... planning, case management and home care required. Knowledge of Utilization Management . Use of computer applications related to health care industry as well… more
- Crouse Hospital (Syracuse, NY)
- …of hospital resources while maintaining the quality of care. + Participates in the utilization management process using standards of care to determine the most ... Coordination Services team is hiring a Care Manager to review the services delivered to patients and compare it...- Five (5) years acute hospital experience. + Case Management or Utilization Management experience… more
- Humana (Tallahassee, FL)
- …health initiatives. + Collaborate with various operational functions in the centralized utilization management team and other shared services. + Participate in ... data (eg Quality measures, Risk Adjustment ratings, chronic condition management , PCP visit rates and effectiveness, and member engagement...quality governance, peer review , and grievance resolution processes. Innovation & Transformation: +… more
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