- Excellus BlueCross BlueShield (Buffalo, NY)
- …Accountabilities: Level I + Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs ... medical review activities pertaining to utilization review, quality assurance, and medical review of complex,...on factors including, but not limited to, budget available, prior experience, knowledge, skill and education as they relate… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …Services area including, but not limited to, Medical and Pharmacy Utilization Management, quality management, member care management, and medical policy processes, ... Level I + Reviews and makes recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include:… more
- The County of Los Angeles (Los Angeles, CA)
- …NEEDS OF THE SERVICES ARE MET AND IS SUBJECT TO CLOSURE WITHOUT PRIOR NOTICE. TYPE OF RECRUITMENT: OPEN COMPETITIVE OPPORTUNITY JOB OPPORTUNITY INFORMATION: Current ... implement, and maintain strategic and operational initiatives for nursing workforce utilization . The incumbent will monitor and trend workforce metrics to develop… more
- Penn Medicine (Philadelphia, PA)
- …integrated health care, achieve clinically appropriate and financially sound resource utilization , support the insurance verification team, clinical staff and verify ... payer reimbursement.Asses clinical information for appropriateness of settling and utilization of resources to optimize patient outcomes and cost effective.Provide… more
- Evolent (Trenton, NJ)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... processing prior authorization requests in accordance with departmental policies, regulatory requirements, and client contractual agreements. **Collaboration… more
- TXNM Energy (Albuquerque, NM)
- …be covered by NERC CIP cyber security standards. If the position is covered, prior to being hired, promoted, or transferred into the position, the candidate must ... Risk Assessment, which includes identity verification and a criminal background check. Prior to being granted unescorted access to cyber secure areas, the candidate… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …outpatient service requests. + Reviews cases referred by the prior -authorization non-clinical medical management coordinator and pre-certification technician staff ... presents cases to ensure quality care while advocating for appropriate utilization of health system resources consistent with health plan's policy, criteria… more
- Molina Healthcare (FL)
- …plan in the development and execution of care management and utilization management programs. Develops clinical practice guidelines and oversees appropriateness and ... support for design/implementation/execution for programs related to quality improvement, utilization management, care management, predictive modeling and disease management.… more
- Ventura County (Ventura, CA)
- …368 hours after 15 years of service or other public service. *Credit for prior public service may be considered (Management Resolution, | 1202A) + Annual Leave ... is responsible for managing and monitoring the activities of the utilization management, case management, disease management, and quality management teams to… more
- Evolent (Helena, MT)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to make a ... meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and use your… more