- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... in the FPPE/OPPE process. Adhere to employee health requirements. Participate in peer review process. Time/Leave Management : Adhere to tour of duty. Timely… more
- Prime Healthcare (Lynwood, CA)
- …With Us! (https://careers-primehealthcare.icims.com/jobs/237903/rn-case-manager utilization - review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) ... and service! Responsibilities Responsible for the quality and resource management of all patients that are admitted to the...to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity,… more
- Merck (Juneau, AK)
- …Content Creation, Copyright Compliance, Customer Journey Mapping, Customer Relationship Management (CRM) Utilization , Data Analysis, Design Thinking, ... **Job Description** The US Human Health Global Headquarters (HH GHQ) Asset Management Specialist's scope spans over three primary areas: + Responsible for approving… more
- Gerber Collision & Glass (Elmhurst, IL)
- …enhancements. + Develop and implement plans for continuous improvement in system utilization and efficiency. People Management : + Manage people, collaborate, and ... and Protected Veterans. Job Description: The Sr. Manager, Workday Product Management - Financials role leads the strategy, configuration, and optimization of… more
- Blue Cross Blue Shield of Massachusetts (Hingham, 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
- 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
- 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