- 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
- CareFirst (Baltimore, MD)
- …related experience working in Care Management , Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... **PURPOSE:** This position will support the Maryland government programs care management team, specifically the Medicare Advantage line of business. The Care… more
- HCA Healthcare (Corpus Christi, TX)
- …at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical ... to help patients achieve optimal health, access to care, and appropriate utilization of resources, balanced with the patient's resources and right to… more
- St. Luke's University Health Network (Sellersville, PA)
- …clinical mental health/crisis intervention experience required. Previous experience with case management / utilization review and managed care models ... who may require treatment with seclusion/restraints. + Supports the function of utilization management regarding pre-certification process for all intakes and… more
- Elevance Health (TX)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... a State agency.*_ **Preferred Skills, Capabilities and Experiences:** + 1-2 years Utilization Management experience strongly preferred. + Strong oral, written,… more
- GEHA (Lee's Summit, MO)
- …Ratio (MLR), and ensuring integration of pharmacy strategy across population health, utilization management , and quality initiatives for all GEHA products and ... benefit management structures, specialty drug pipelines, formulary design, and utilization management + Strategic and operational leadership in a managed… more
- University Medicine (Providence, RI)
- …provider in order to identify those patients who may benefit from high-risk case management (eg rising risk, frequent ED utilization ). The NCM helps Brown ... SUMMARY: Reporting to the Manager of Case Management , the nurse case manager is responsible for...to the right level of care and decrease unnecessary utilization . The nurse case manager is an active participant… more
- Magellan Health Services (Albuquerque, NM)
- …the management , direct supervision and coordination of clinical and/or nonclinical management staff, including utilization management and intensive care ... and on-going management of designated staff. + Performs care management review activities consistent with Magellan policies, procedures, and standards.… more
- San Antonio Behavioral Health (San Antonio, TX)
- The Utilization Review Coordinator conducts utilization reviews to determine if patients are receiving care appropriate to illness or condition. Monitors ... status of approvals from insurers. Responsible for monitoring adherence to the hospital's utilization review plan to ensure the effective and efficient use of… more
- CVS Health (Hartford, CT)
- …to cover urgent cases can be done from your laptop. **Fundamental Components:** * Utilization management - The medical director will perform concurrent and prior ... Multiple state licensure a plus. **Preferred Qualifications:** Previous Experience in Utilization Management / Claims Determination with another Health Plan… more