- HCA Healthcare (Hendersonville, TN)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... for appeals and denials process, discharge planning, case management, and utilization review /management. + Consults with facility-level staff regarding delegated… more
- Evolent (Sacramento, CA)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... Director you will be a key member of the utilization management team. We can offer you a meaningful...rationale for standard and expedited appeals. + Utilizes medical/clinical review guidelines and parameters to assure consistency in the… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and 3-5 years in a managed care health plan setting. + Strong understanding of Utilization Review , Care Management and Medical Polices. + Knowledge of APR DRG, ... provide a clinical summary of a member's course of illness, history of service utilization and costs incurred. + Analyze provider utilization trends and audit… more
- MaineGeneral Health (Augusta, ME)
- …and resource overutilization. + Lead or actively participate in the Utilization Review Committee, ensuring compliance with regulatory requirements, reviewing ... and appeals processes. + Provide ongoing education to staff on utilization review , documentation, and compliance, while promoting interdepartmental collaboration… more
- University of Miami (Miami, FL)
- …of UMHC SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote. The incumbent conducts ... initial, concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review...reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the… more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management, care transition, collaboration with physicians and ... experience in a hospital environment preferred. + Previous case management, utilization review , and discharge planning experience highly preferred. Home… more
- UNC Health Care (Hendersonville, NC)
- …for behavioral health services. Working closely with behavioral health clinicians, utilization review , case management, and finance teams, the Intake ... to ensure appropriate care transition and patient placement. + Liaise with utilization review , psychiatry leadership, risk management, and/or legal department as… more
- Guthrie (Sayre, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... for alternate levels of care. The Acute Case Manager also performs Utilization Management throughout the continuum of care in collaboration with other internal… more
- Adecco US, Inc. (Tallahassee, FL)
- …license accepted if current and compliant + Case Management, Nursing, or Utilization Review certification preferred **Benefits** + Comprehensive Medical, Dental, ... join its Case Management team. This role focuses on care coordination, utilization management, patient throughput, and discharge planning across the continuum of… more
- Veterans Affairs, Veterans Health Administration (Tomah, WI)
- …in the last two years. Demonstrated experience in policy development, medication utilization review , and cost containment strategies. Experience with Pharmacy ... Summary The Formulary and Drug Utilization Manager position guides the appropriate medication use...cost-efficiency measures are met. Responsibilities The Formulary and Drug Utilization Manager position is responsible for managing medication … more