- Community Based Care of Brevard, Inc. (Brevard, FL)
- …Position Summary: This position is responsible for the clinical coordination, utilization management , and authorization of initial and ongoing services ... alternative funding sources whenever possible. The position facilitates Team Review Meetings and the utilization review...the most efficient and effective use of agency resources. Utilization Management - Essential Function: Ensure that… more
- US Tech Solutions (Columbia, SC)
- …behavior change and increase member program engagement. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services ... assist each other. **Responsibilities:** + Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience required. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization , case management interventions. Update the plan of care… more
- UPMC (Pittsburgh, PA)
- …of health insurance experience preferred. + 1 year of experience in clinical, utilization management , home care, discharge planning, and/or case management ... face-to-face assessments that include a clinical assessment and treatment, a review of the medical, functional, behavioral , pharmaceutical, and social… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …a difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre ... policies and procedures to determine clinical appropriateness. * Completes review of both medical documentation and claims data to...* 1+ years of managed care experience (eg case management , utilization management and/or auditing… more
- Elevance Health (Overland Park, KS)
- …to clients/ members. The medical director provides clinical expertise in all aspects of utilization review and case management . Provides input on the ... means that the medical director is directly involved in Utilization Management and Case Management ....state or territory of the United States when conducting utilization review or an appeals consideration and… more
- Commonwealth Care Alliance (Boston, MA)
- …medical, behavioral , and social complexities that require intensive care management and care delivery. Within the CIC Program, the Registered Nurse (RN) ... influence the clinical outcomes of assigned patients by impacting acute care utilization , ensuring optimal treatment for chronic disease management , and closing… more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- The County of Los Angeles (Los Angeles, CA)
- …predictive and prescriptive analytics, to support data-driven program design and management ; and produces dashboards, reports, and other advanced data visualization ... and prevention services including but not limited to forecasting utilization and cost, cost/finance analyses, cost-effectiveness analyses, and predictive/prescriptive… more
- Fallon Health (Worcester, MA)
- …behavioral and rehabilitative services. **Responsibilities** **Primary Job Responsibilities** ** Utilization Review and Care Coordination and Collaboration** + ... or social determinants of health needs and refer to Behavioral Health as needed. + Completes ongoing review...member to return to the community. + Conducts concurrent utilization review for members that are in… more
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