- Insight Global (Amarillo, TX)
- …to streamline and improve the quality of the prior authorization and drug utilization management processes. Motivates and works with clinical staff to ensure ... accordance with member benefits and coverage criteria within defined turn-around times. Review of prior authorization requests in accordance with member benefits and… more
- Children's Home Healthcare (Amarillo, TX)
- …authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional ... on a 60 days basis per company policy. 9. Review /approve plan of care and all related documents prior...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Northwell Health (Melville, NY)
- … Review standard and regulations. Performs concurrent and retrospective utilization management using evidenced-based medical necessity criteria; conducts ... of illness and intensity of services provided. Performs PRI's (Patient Review Instrument), as needed. Performs related duties as required. All responsibilities… more
- Highmark Health (Columbus, OH)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... both internally developed and vendor-sourced criteria. This includes proactive monitoring, review , and timely updates in response to new evidence, regulatory… more
- Humana (Oklahoma City, OK)
- …health first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... learn new systems **Preferred Qualifications** + Bachelors Degree + Experience with Utilization Review and/or Prior Authorization, preferably within a managed… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... continuous care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and… more
- UPMC (Pittsburgh, PA)
- …by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care ... We are hiring a full-time Clinical Care Manager to provide face-to-face NICU case management . The Clinical Care Manager will provide case management to infants… more
- Sharp HealthCare (San Diego, CA)
- …experience, preferably in a managed care setting. **Other Qualification Requirements** + Utilization , Case Management , or Quality Management certification ... **What You Will Do** Supervise the effective implementation of the Ambulatory Case Management (ACM) programs that includes the management of patients in the… more
- Hackensack Meridian Health (North Bergen, NJ)
- …benefits package. + Engage in the teaching, consulting, and advising of the care management and utilization review departments and hospital leadership. + ... outcomes. + Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) preferred. + Membership in the American… more
- Carle Health (Champaign, IL)
- …for improving patient care outcomes. The incumbent will have a deep understanding of utilization review and case management principles, case management ... experience 2+ years Responsibilities Maintain current knowledge of case management and utilization review trends including the entire continuum of care… more