- Henry Ford Health System (Troy, MI)
- …quality of care provided by the primary care team. He/she works with utilization management reports, corporate data stores, and information services to optimize drug ... waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental in guiding...in primary care or managed care is strongly desired. Prior experience and knowledge or integrated health systems. Exemplary… more
- Centene Corporation (Tallahassee, FL)
- …applied behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida * Schedule: ... (BH) and/or autism spectrum disorder needs and clinical standards + Performs prior authorization reviews related to BH to determine medical appropriateness in… more
- US Tech Solutions (Columbia, SC)
- …to hire) **Job Description:** + NICE TO HAVE skill sets/qualities: Utilization management experience and /or Appeals experience /strong clinical skills Behavioral ... experience + A typical day would like in this role: Process prior authorization requests for Medicare Advantage line of business. Previous Medicare experience… more
- Ascension Health (Baltimore, MD)
- **Details** + **Department:** Utilization Management + **Schedule:** Part-time. Monday-Friday, 8:00AM-4:30PM. + **Facility:** St. Agnes Hospital + **Location:** ... care services regarding admissions, case management, discharge planning and utilization review. Responsibilities: + Review admissions and service requests within… more
- Actalent (Santa Barbara, CA)
- …Claim Top Skills Details Data entry,Concurrent review, Prior authorization,Health care,Medicare,Managed care,Medical management,Case management, Utilization ... services team members in the implementation and management of Utilization Management, Case Management, Disease Management, Population Health, Care Coordination,… more
- Actalent (Redlands, CA)
- Job Title: Case Manager - Utilization ManagementJob Description Join our dynamic Utilization Management team as a Case Manager, where you will play a pivotal ... cases daily. + Review designated requests for referral authorizations and prior authorizations proactively, concurrently, or retroactively. + Ensure compliance with… more
- Hunterdon Health Care System (Flemington, NJ)
- Position Summary The Utilization Review Specialist monitors adherence to the hospital's utilization review plan to ensure the effective and efficient use of ... the application of evidence-based criteria or guidelines, and through authorization/ prior authorization under the provisions of an applicable health insurance… more
- CVS Health (Richmond, VA)
- …do it all with heart, each and every day. **Position Summary** The Utilization Management (UM) Nurse Consultant is a remote, full-time role responsible for ... services using evidence-based clinical criteria. This position involves conducting utilization reviews, collaborating with healthcare providers, and supporting care… more
- Molina Healthcare (Vancouver, WA)
- …family include those involved in formulary management (such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and ... and quality initiatives under the direction of leadership. + Monitors drug utilization and assists leadership team in understanding quality and cost control issues… more
- CVS Health (Topeka, KS)
- …opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and lends expertise to other internal and external ... constituents in the coordination and administration of the utilization /benefit management function. + Typical office working environment with productivity and… more