- Zelis (GA)
- …Revenue Management: Manage and oversee revenue targets, including budgets, forecasts, and product utilization review for the assigned book of business. + Client ... healthcare communications solutions. + Demonstrated success in revenue management and increased utilization within an assigned book of business of mid to large… more
- Elevance Health (Miami, FL)
- …or equivalent. Requires a minimum of 4 years of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license ... improvement initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes. + Assesses and applies… more
- Sharp HealthCare (La Mesa, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... instruction. May schedule patient appointments.In partnership with physician, may review pre-printed teaching materials or written instructions from the provider… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Nursing 4 years nursing in an acute hospital or 2 years Case Management, Utilization Review , or Discharge Planning experience in an acute hospital PREFERRED ... includes coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case Managers perform concurrent … more
- HCA Healthcare (San Antonio, TX)
- …Bachelor of Science in Nursing + At least one year experience in utilization review , resource management, discharge planning or case management. Prior Case ... functional and self-care abilities; 2) facilitate system access and appropriate utilization of services; 3) facilitate communication and coordination of efforts… more
- UnityPoint Health (Cedar Rapids, IA)
- …home care. Responsible for case coordination of patients and insurance precertification/ utilization review . Patients served include adult and geriatric. St. ... coverage. + Coordinates cases with community agencies, referral sources. + Manages utilization review for own patients with insurance carriers. + Provides… more
- Trinity Health (Des Moines, IA)
- …and Process Improvement. Physician Relationships. Hospital Management and operations. Utilization review /physician advisor Graduate Medical Education Decision ... relationship for centralized medical staff functions such as quality, safety and utilization review and to the RHM President and other members of the Executive… more
- HCA Healthcare (Austin, TX)
- …interdepartmental service coordination. + Actively participates in the Performance Improvement and Utilization Review programs. + Assumes a role in the ... improvements in work methods. + Effective in cost control and resource utilization . 9) Key Relationships + Maintains positive relationships with internal customers.… more
- Elevance Health (FL)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical case reviews with attending physicians or other ordering providers to discuss review determinations. + Serves as a resource and consultant to other areas of… more
- Intermountain Health (Salt Lake City, UT)
- …+ Care Management Certification + Demonstrated experience in case management, utilization review , or discharge planning. **Physical Requirements** + Ongoing ... patients for proactive interventions using specific screening criteria, medical record review , payor models, medical risk scores, or referrals. Assesses patients'… more
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