- Bon Secours Mercy Health (Cincinnati, OH)
- …cost per test for both in-house and referral tests. + Develop and chair a utilization management review committee and partner with the prior authorization ... team. + Review high-cost and high-volume referral tests for clinical appropriateness...and problem-solving skills. + Excellent communication, collaboration, and project management skills. + Proven ability to influence physician behavior… more
- Elevance Health (Norfolk, VA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience.… more
- St. Luke's University Health Network (Stroudsburg, PA)
- …clinical mental health/crisis intervention experience required. Previous experience with case management / utilization review and managed care models ... who may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and… more
- CommonSpirit Health (Rancho Cordova, CA)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... performed and communicating with department manager and director the outcomes of the review and any identified issues or barriers. **Core Duties:** + Compiles data… more
- Banner Health (Mesa, AZ)
- …both internal and external customers. Manages data as related to operations. Performs Utilization Management functions as required by facility CORE FUNCTIONS 1. ... and advanced technology that includes the da Vinci Surgical System. Becker's Hospital Review named Banner Desert Medical Center as one of the top 50 busiest… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Blue Cross Blue Shield of MN! This role is a key contributor to our Utilization Management team, helping to shape smarter, data-driven decisions that improve how ... degree. * Experience with health care data (focus on Utilization Management a plus) * Experience with...discover more about what we have to offer, please review our benefits page. Role Designation Hybrid Anchored in… more
- CommonSpirit Health (Rancho Cordova, CA)
- …leading up to or including supervisory role highly preferred + Experience in Utilization Management , Case Management or Care Coordination, Managed Care ... and communicating with department manager and director the outcomes of the review and any identified issues or barriers. **Accountabilities:** + Compiles data for… more
- Highmark Health (Little Rock, AR)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... and the proper action to complete the retrospective claim review with the goal of proper and timely payment...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
- Elevance Health (Seven Fields, PA)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May...hire. + Child and Adolescent board certification preferred. + Utilization management experience preferred. For candidates working… more
- Elevance Health (Woodbridge, NJ)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... years of managed care experience preferred. + Consulting experience preferred. + Utilization management experience preferred. + Master's Degree preferred. (MBA,… more