- 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
- UCLA Health (Los Angeles, CA)
- …medical leadership experience, required + Minimum of 2 years of experience in Utilization Management , required + Minimum of 2 years in developing evidence-based ... within a health plan, required + Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case management , required +… more
- Abbott (Alameda, CA)
- …and accountability across business domains to support ethical and effective data utilization . **Demand/Intake Management ** + Build deep relationships with our ... disease-state and live life to the fullest. As the IT Director Business Relationship Management - Global Data Analytics, you will play a pivotal role in advancing… more
- CareFirst (Baltimore, MD)
- …in mental health, psychiatric setting. **Preferred Qualifications:** + 2 years experience in Medical Review , Utilization Management or Case Management at ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Veterans Affairs, Veterans Health Administration (Redlands, CA)
- …possesses intimate knowledge of Fee federal regulations, VHA guidelines, medical review criteria, utilization management processes, clinical documentation ... given to nurses with experience in Care Coordination nurses with case management /fee service training, and nurses with leadership training or demonstrated competence… more
- Veterans Affairs, Veterans Health Administration (Tuscaloosa, AL)
- …RN possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: Experience in case management , care coordination, and clinic utilization . Physical… more
- HCA Healthcare (Mcallen, 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
- HCA Healthcare (Houston, 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
- 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
- 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