- Prime Healthcare (Ontario, CA)
- …and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and ... institution in a Health and Human Services field is highly preferred.2. Utilization Review experience is highly preferred.3. Clinical experience in acute… more
- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams… more
- UPMC (Pittsburgh, PA)
- …for various clinical and non-clinical disciplines across UPMC, including regular utilization review , spend analysis, product introductions and trials. + ... Supports clinical specialty committees focused on product introductions, value analysis and utilization review consistent with UPMC policies and procedures. +… more
- Hartford HealthCare (Manchester, CT)
- …Region serves a region of 300,000 people in 19 towns. POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician ... of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual, Milliman Care… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... nursing experience or case management experience. + 3 Years case management, utilization review , care coordination experience. + California Registered Nurse (RN)… more
- Centene Corporation (Cheyenne, WY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Molina Healthcare (AZ)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …+ Knowledge of NCQA UM accreditation requirements, Massachusetts, and Rhode Island utilization review regulations + Proficiency in Microsoft Office (Word, Excel, ... utilization management regulatory and accreditation standards, such as NCQA, Massachusetts utilization review regulations, Rhode Island utilization … more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review - Review prospectively, concurrently and retrospectively, all… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range ... I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of managed care products and… more
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