- 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
- Aspirus Ironwood Hospital (Wausau, WI)
- …System Care Coordination is responsible for system-wide Care Coordination functions ( Utilization Review , Social Work, Navigation, and Case Management) including ... is required. + A minimum of five years of experience in care management or utilization review + A minimum of five to seven years of leadership experience in care… more
- Sharp HealthCare (La Mesa, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... Management and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM will:Conduct initial … 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 ... medical record and provides information to the department head as indicated. + Utilization review and utilization managementThe RN CM I will:Conduct initial … more
- Nuvance Health (Danbury, CT)
- …of hospitalization, LOC status, LOS management, continued stay decisions, clinical review of patients, utilization review activities, resource ... appropriate. * Maintains knowledge of regulatory and accreditation requirements related to utilization review (UR) LOC and clinical documentation. * Conducts… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … 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
- Houston Methodist (Houston, TX)
- …strategic oversight for all hospital-based Case Management Directors and the Central Utilization Review Director across the system. This position is responsible ... enterprise-wide initiatives aimed at optimizing patient progression of care, aligning utilization review practices, enhancing discharge planning processes, and… more