- Dartmouth Health (Lebanon, NH)
- …Position Objective * The Case Manager will spend time specific to the role of case management and utilization review : * Lead a collaborative process with the ... 30 days of hire. * Board Certification in Case Management (CCM or CMC) preferred. If not certified, willingness...clinical outcomes within the desired time frame. * Conducts review for appropriate utilization of services from… more
- HCA Healthcare (Campbell, CA)
- …to ensure functions such as Claims System Configuration, Customer Service, Utilization Management and Compliance are executing their assigned accountabilities. ... configuration audits as needed + Draft and prepare for review by the President of SCCIPA and CFO Letters...to apply for our Contract Specialist opening. We promptly review all applications. Highly qualified candidates will be directly… more
- Veterans Affairs, Veterans Health Administration (Tomah, WI)
- …in the last two years. Demonstrated experience in policy development, medication utilization review , and cost containment strategies. References: For more ... Summary The Formulary and Drug Utilization Manager position guides the appropriate medication use strategy for optimal patient safety, cost effectiveness, and… more
- Humana (Columbia, SC)
- …focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience, + working with health insurance ... of services provided by other healthcare professionals in compliance with review policies, procedures, and performance standards. Represents Humana at Administrative… more
- The Cigna Group (Raleigh, NC)
- …and model monitoring / maintenance using a broad range of medical, prescription drug, utilization management , and third-party data. In this role you will work ... practices and writes clean, documented, and well-structured code + Ability to peer review + Champions a culture of documentation and logging + Ability to own… more
- Sharp HealthCare (San Diego, CA)
- …all notes and billing daily.Completes all tasks and documentation needs (ie utilization management , plan of care, medical necessity reviews) based on ... requirements.PT Spec II additional standardsSupports clinic needs for documentation review and training. + Professional and Departmental DevelopmentIdentifies needs… more
- Health Care Service Corporation (Richardson, TX)
- …experience + Hematology and Oncology experience + Peer to peer experience + Utilization Management / review experience **This is a Telecommute (Remote) role: ... Must reside withing 250 miles of the office or anywhere within the posted state.** **Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!** **Pay Transparency Statement:** At Health Care Service… more
- Insight Global (Woonsocket, RI)
- …projects related to clinical enablement, such as prior authorization workflows within utilization management and the MedCompass platform for all prior ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- AdventHealth (Fletcher, NC)
- …concerns. + Performs the functions of the clinical supervisor, intake, scheduling, quality review , utilization management medical records as needed. + ... Ensures the agency employs qualified personnel that meet all state and federal requirements. Collaborates with the talent acquisition and HR team related to all personnel related matters. + Accountable to meet & exceed national benchmarks in key performance… more
- Banner Health (Casper, WY)
- …networks, and regulatory agencies. MINIMUM QUALIFICATIONS Must possess knowledge of case management or utilization review as normally obtained through ... achieve outcomes and positively affect transitions of care. Care Coordination/Case Management is a unique, important department that supports patients, families and… more