- 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
- Fairview Health Services (Edina, MN)
- …for services provided + Completes the requirements of various payers and utilization management reviewers to obtain authorization for treatment. Demonstrates the ... as an interdisciplinary team member. Responsible, as assigned, for the management of caseload. **Job Expectations:** Works collaboratively with the physician and… more
- Atlantic Health System (NJ)
- …chart documentation. 8. Incorporates use of criteria sets in context of utilization management . 9. Performs other related duties as assigned. Required:1. ... plans. 2. Engages to enhance functioning, effective coping, illness management , self- management , wellness and quality of life....100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 -… more
- UCLA Health (Los Angeles, CA)
- …The Home Health ICM Coordinator plays a key role in supporting our Utilization Management team to ensure safe, high-quality, and cost-effective care for ... patients enrolled in UCLA Medicare Advantage and Intensive Case Management programs. Under the supervision of the RN Assistant Director, you will coordinate… more
- 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
- Centene Corporation (Phoenix, AZ)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more