- 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
- Blue KC (MO)
- …making decisions that may not have universal agreement, particularly around utilization review activities. + Review individual member experiences to identify where ... initiatives by providing direction to physicians and other providers, Provides utilization management for medical, surgical and pharmacy activity. + Participates in… more
- Commonwealth Care Alliance (Boston, MA)
- …Duties & Responsibilities:** + Actively monitor health plan medical expense, utilization , and unit cost year over year trends, performance against targets, ... performance of Clinical Operations and their direct impact on medical expense and utilization + Guide teams in translating insights into operational action, with a… more
- Community Health Systems (Las Cruces, NM)
- …AMR Coordinator Clinics provides AMR education and development that promotes efficient utilization and optimization of the AMR. This role will also simultaneously ... clinicians to monitor performance and to ensure AMR competence and adherence to utilization of best practice workflows and policies. This role will be heavily… more
- J&J Family of Companies (Nashville, TN)
- …experience in Oncology. . Must be familiar with Microsoft Word, Excel, PowerPoint, and utilization of computers and remote technologies. . Prior experience as an ... Our strength in healthcare innovation empowers us to build a world where complex diseases are prevented, treated, and cured, where treatments are smarter and less invasive, and solutions are personal. Through our expertise in Innovative Medicine and MedTech,… more
- Catholic Health (Buffalo, NY)
- …Management preferred + Two (2) years acute care RN experience required + Preferred prior insurance /managed care/ utilization review experience in the role of a ... Case Manager or Disease Manager, Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary team + Has a good understanding of the Social… more
- Catholic Health (Kenmore, NY)
- …EXPERIENCE + Two (2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a ... Case Manager or Disease Manager, Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary team + Has a good understanding of the Social… more