- Veterans Affairs, Veterans Health Administration (Temple, TX)
- …possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... Responsible for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Responsibilities… more
- Prime Therapeutics (Baton Rouge, LA)
- …as a strategic partner during client project requirement sessions, including utilization management , coverage exceptions, and regulatory requirements + Establish ... skills, and provide coaching and feedback to staff consistent with performance management practices + Resolve complex and/or escalated client and/or member issues… more
- Veterans Affairs, Veterans Health Administration (Sheridan, WY)
- …Possesses intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation ... responsibility for the coordination of care focused on patient education, self- management , and customer satisfaction throughout the continuum of care. Follows… more
- Insight Global (Newtown, PA)
- …driven projects - 5+ years of experience in healthcare domain understanding Medical Management , Utilization management , Provider or claims systems - Strong ... oriented systems analyst that communicates process solutions, recommendations, and issues to management on a regular basis. We are a company committed to creating… more
- Fairview Health Services (Maplewood, 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
- 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
- University of Rochester (Rochester, NY)
- …such as Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient Accounts, ... attorneys, MVA and WC carriers, outside hospitals, governmental agencies, and external review agencies. + Serves as a liaison to patients, physicians, nursing,… 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
- 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