- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …individuals facing mental health challenges, while working behind the scenes? If so, ** Utilization Management** might be the perfect fit for you\! In this role, ... Health settings** \(both inpatient and outpatient\)\. + Prior experience in ** Utilization Management** or **Managed Care** \. + Strong **communication and… more
- Penn Medicine (Lancaster, PA)
- …physician, nurse and patient regarding the contents, therapeutic action, utilization and possible adverse reactions or interactions of medication. + Responds to ... teaching aides or computer-generated warning or supplemental information. + Conducts drug utilization reviews to assure the quality of drug use. Determines if… more
- Henry Ford Health System (Troy, MI)
- …judgment and applying appropriate medical necessity criteria. Provides clinical utilization management expertise to provide education, formal and informal and ... ancillary departments, physicians, and payers. EDUCATION AND EXPERIENCE: + Registered Nurse with a valid, unrestricted, State of Michigan License required. +… more
- WellSpan Health (Lewisburg, PA)
- …effectively manager cost and maximize employee satisfaction and resource utilization . **Duties and Responsibilities** **Essential Functions:** + Facilitates and ... + Creates customized reports to present data valuable to logistics manager, nurse managers, department directors, and finance partners for resource management. +… more
- McLaren Health Care (Pontiac, MI)
- …activities that occur in a sterile environment. 3. Demonstrates competency in utilization of specified equipment required for patient care, including but not limited ... obtaining current accurate information and expand knowledge base through utilization of appropriate learning experiences and attending mandatory annual in-services.… more
- Molina Healthcare (Houston, TX)
- …cost-effective member care. We are seeking candidates with a RN licensure, Utilization Management knowledge and Medicare Appeals is strongly preferred. Work hours ... multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At least 2… more
- Covenant Health (Lubbock, TX)
- …Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review, discharge planning, documentation of ... Degree in Nursing degree/diploma. + Upon hire: Texas Registered Nurse License. + 2 years of Acute care nursing...+ 1 year of experience in care management or utilization review in any setting or successful completion of… more
- Essentia Health (Detroit Lakes, MN)
- …support team including genetic counselors, nutritionists, social workers, nurse navigators, behavioral therapists, certified cancer-care physical therapists and ... both inpatient and ambulatory facilities, ensuring top-tier electronic medical record utilization . Job Specifics + **Consultative Call Only** : Hospitalists handle… more
- Dentsply Sirona (Pensacola, FL)
- …diagnosis codes, product categories (eg, catheters, drainage supplies), and utilization justification for accuracy and completeness.** + **Maintains a thorough ... standards.** + **Communicates proactively with external referral sources (urologists, nurse practitioners, home health agencies) to obtain missing or corrected… more
- University of Utah Health (Salt Lake City, UT)
- …issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes. + Negotiates with third party payers ... relative to benefit levels, eligibility, utilization review, and reimbursement. + Identifies actual and potential...following** + Current license to practice as a Registered Nurse in the State of Utah, or obtain one… more