- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Molina Healthcare (Buffalo, NY)
- JOB DESCRIPTION Job SummaryProvides non-clinical administrative support to utilization management team and contributes to interdisciplinary efforts supporting ... * Provides telephone, clerical and data entry support for the care review team. * Provides computer entries of authorization request/provider inquiries, such as… more
- Prime Healthcare (La Palma, CA)
- …Discharge Plan. Qualifications EDUCATION, EXPERIENCE, TRAINING 1. Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and ... Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist… more
- Prime Healthcare (Boonton Township, NJ)
- …Plan. Qualifications Education and Work Experience + Knowledge of Discharge Planning/ Utilization Management / Case Management terminology and functions, ... Responsible for the coordination of the various activities of the Case Management Department under the direction of the assigned Case Manager/Social Worker assist… more
- Penn Medicine (Princeton, NJ)
- …+ Effective and timely completion of documentation as well as coordination with utilization management reviewer . + Performance Improvement + Participate in ... treatment, treatment plan implementation and coordination, discharge planning, and case management with social service support systems, schools and other relevant… more
- Beth Israel Lahey Health (Burlington, MA)
- …the medical necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue integrity, these specialized ... Analyst works with physicians, the payers and inpatient case management team to validate the medical necessity of the...necessity of the hospital care. Using the concepts of utilization review , clinical documentation improvement and revenue… 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
- UPMC (Bridgeville, PA)
- …coordination of benefits, complaints and grievance guidelines and prescription drug utilization management required + Thorough knowledge in MS Office ... UPMC Rx Partners is looking for a full time Pharmacy Clinical Review Specialist to join their dedicated team! You will oversee administrative and system processes… more
- The Cigna Group (Bloomfield, CT)
- …Performance Monitoring, regional Grievance Subcommittee, regional Utilization Management Subcommittee, and regional Peer Review Subcommittee activities, ... the regional level. Manage effective DHMO and PPO Quality Management Programs (QMPs) at the regional level to meet...incidents > 90% closed in 30 days. + Support review and enhancements to the Periodic Quality Assessment Process… more
- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier… more