- HCA Healthcare (Englewood, CO)
- …patient through the continuum of care, including discharge planning. Oversee utilization management process including verification of insurance coverage, ... and family needs with the efficacious and cost effective utilization of resources. Coordinates patient, family, physicians and all...pre-authorization, resource management and overall management of patients within… more
- CVS Health (Hartford, CT)
- …basis to support 24/7 appeals work * IRE monitoring and tracking and Utilization Management Strategy support * Collaborative work with Medicare Quality and ... appeal nurses; supervision and participation in the Second Look Review (SLR) process * Provide direct support to the...policy and appeals to the appeal nurses and territory Utilization Management Staff * Participate in ongoing… more
- UCLA Health (Los Angeles, CA)
- …care experience post residency, required + Minimum of 2 years of experience in Utilization Management + 2 or more years of experience working managed care ... team on safe, effective medication use; participate in drug review rounds and P&T Committee. + Contribute to interdisciplinary...+ Knowledge of Medicare Advantage experience with utilization management , quality improvement, or case … more
- HCA Healthcare (Cypress, TX)
- …national standards for case management scope of services including + Utilization Management supporting medical necessity and denial prevention + Transition ... patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and...Management promoting appropriate length of stay, readmission prevention and… more
- St. Luke's University Health Network (Allentown, PA)
- …for admission and/or referral to appropriate level of care. + May assist in the utilization management of psychiatric cases in the absence of the utilization ... appropriate to the age of the patient treated. + Performs admission review on all inpatients. Attends daily patient rounds and shares professional knowledge,… more
- Humana (Jefferson City, MO)
- …providers. + Utilization management experience in a medical management review organization, such as Medicare Advantage, Managed Medicaid, or Commercial ... + Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard… more
- CareFirst (Baltimore, MD)
- …Appeals and Grievances in a healthcare payor organization. 2 years' experience in Medical Review , Utilization Management or Case Management at CareFirst ... of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals.… more
- Fairview Health Services (Minneapolis, MN)
- …knowledge of utilization review and collaborates with the Utilization Management Specialists to insure the ongoing, comprehensive monitoring and ... in the treatment planning process. + Coordinates treatment planning and leads management of each case. + Coordinates/facilitates the development of treatment plan by… more
- University of Washington (Seattle, WA)
- …the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management ), ... communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity… more
- HCA Healthcare (Gainesville, FL)
- …Case Management is preferred + BSN is preferred + Certification in Case Management , Nursing or Utilization Review is preferred HCA Florida North Florida ... with physicians, patients, families, hospital staff, and outside agencies + Performs utilization management reviews and communicates information to third party… more
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