- Providence (Everett, WA)
- …care environment. Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, ... in area of specialty upon hire. + 1 year - experience in care management or utilization review in any setting or successful completion of TIPS program or… more
- CareFirst (Baltimore, MD)
- …working in Care Management , Home Health, Discharge Coordination and/or Utilization Review . **Preferred Qualifications:** + Bilingual - fluent in Spanish. ... of care. Utilizing experience and skills in both case management and utilization management including...care. Applies sound clinical knowledge and judgment throughout the review process. Follows member benefit contracts to assist with… more
- AON (Chicago, IL)
- …and ability to work with others. + Experience in resource deployment and utilization management . + Strong interpersonal skills, with the ability to interact ... clients. The duties of this role include: + Program review for accurate reserving + Maximizing claims service and...work with others. + Experience in resource deployment and utilization management . + Strong interpersonal skills, with… more
- Stanford Health Care (Palo Alto, CA)
- …initiatives and guidance for product evaluation teams. + Train Value Based Management committee members to analyze and review data effectively during ... trends within health care and academic medical centers that may impact product/service utilization or Value Based Management processes. + Collaborate with key… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- … experience. * 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Compensation ... US Minimum Experience Required 1+ years of managed care experience, eg case management /health coach, utilization management and/or auditing experience. Shift… more
- Elevance Health (Costa Mesa, CA)
- …+ Conduct ongoing and ad hoc reviews focused on specialty tiers, utilization management , STARS performance, and high-cost/high-trend drugs. **Market Monitoring & ... collaboration with cross-functional partners-including Clinical Pharmacy, Compliance, STARS, Medical Management , Actuary, Product, and Rebate teams-to ensure formularies are… more
- AdventHealth (Hinsdale, IL)
- …. BSN . Health-related Master's degree or MSN . Prior Care Management / Utilization Management experience **LICENSURE, CERTIFICATION OR REGISTRATION ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- AdventHealth (Parker, CO)
- …Nursing + Certified Case Manager (CCM) + Accredited Case Manager (ACM) + Experience in utilization management or case management This facility is an equal ... Manager is under the general supervision of the Care Management Supervisor or Manager or Director of Nursing and...physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge… more
- ChenMed (Virginia Beach, VA)
- …explain primary care provider role. + Facilitates patient/family conferences to review treatment goals, optimize resource utilization , provide family education ... re: goals of care, palliative care and hospice. + Utilization /Financial Management -managing resource utilization and...quality of health care. + Applies skills in peer review to promote a culture of excellence. + Anticipates… more
- Humana (Frankfort, KY)
- …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