- Hackensack Meridian Health (Hackensack, NJ)
- …Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... The Utilization Review Physician collaborates with the healthcare team in the management and resolution of activities that assure the integrity of clinical… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... **The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the integrity of… more
- Cedars-Sinai (Santa Monica, CA)
- …support activities to address physician and staff concerns such as facilities management , patient billing, utilization management , quality management ... front office workflow. This position also assists with providing a review of Patient Service Representative administrative skills, assessing the workflow of… more
- Veterans Affairs, Veterans Health Administration (Columbia, SC)
- …possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …This individual pulls and synthesizes data across multiple domains, including utilization management , prior authorization, claims, denials, and appeals. Their ... focus in the department include but are not limited to provider, health management , quality, product development and client/member analytics. A typical day for the… more
- AmeriHealth Caritas (Philadelphia, PA)
- …and compliance indicators + **Cross-Functional Collaboration** + Coordinate with Claims, Utilization Management , Member Services, Legal, and Compliance to ensure ... Friday from 8a EST to 5p EST **Responsibilities** + **Leadership and Staff Management ** + Supervise daily activities of assigned Appeals & Grievance staff, including… more
- Blue Cross Blue Shield of Massachusetts (Quincy, MA)
- …health care settings (Inpatient, outpatient, or differing levels of care). * Utilization Management experience, preferred * Active licensure in Massachusetts is ... and regulatory standards to create, follow and appropriately document comprehensive care management plans. * Review medication list and educate members with… more
- University of Rochester (Rochester, NY)
- …Medicare and other payer regulations for the coordination of benefits. + Notifies Utilization Management of clinical requests by third party payers. + Maintains ... considerations._ **Responsibilities:** GENERAL PURPOSE Manages and provides financial account management for all urgent, emergent, and pre-admission visits with a… more
- Cedars-Sinai (Culver City, CA)
- …and clinical (based on scope of practice) support activities including facilities management , patient billing, utilization management , quality management ... the approved standard work. This position also assists with providing a review of clinical and administrative skills, assessing the workflow and monitoring… 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 ... Disorders is a critical component of the BCBSMN Care Management team. Behavioral Health Care Advisors will provide clinical...discover more about what we have to offer, please review our benefits page. Apply Here: PI280624182 Minimum Education… more
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