- Zelis (NJ)
- …Management: Manage and oversee all revenue targets, including budgets, forecasts, and product utilization review for the assigned book of business. + Client ... verticals is required. + Demonstrated success in revenue management and increased utilization within an assigned book of business. + Excellent written and verbal… more
- Mental Health Association of SCK (Wichita, KS)
- …and philosophy of the program. + Ensures compliance with payer systems, including utilization review functions. + Completes quality assurance and utilization ... review measures including peer reviews, CQI, annual and strategic planning, etc. + Manages operational expenses within an approved budget. Prepares and processes necessary program reports. + Provides therapy services to clients and patients, individually… more
- HCA Healthcare (Live Oak, TX)
- …and actively participating in daily multidisciplinary and bedside rounds, completing drug utilization review to promote rational drug therapy, leading and ... to promote rational drug therapy and make improvements identified by drug utilization evaluations. + You will provide accurate and timely medication information to… more
- Nuvance Health (Danbury, CT)
- …with CMS, Joint Commission, and other regulatory bodies related to discharge planning, utilization review , and care transitions. 6. Monitor and analyze key ... - One of America's 50 Best Hospitals * Surgical Review Corporation (SRC) - Robotic Center of Excellence *...and administrative leaders to optimize patient flow and resource utilization . 10. Oversee the development of individualized discharge plans… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets and ... 1+ years of managed care experience; eg case management/health coach, utilization management and/or auditing experience. * Outstanding customer service and… more
- Providence (Everett, WA)
- …in area of specialty upon hire. + 1 year - experience in care management or utilization review in any setting or successful completion of TIPS program or Case ... Accountabilities include assessment and planning, coordination of care, resource utilization management and/ or review , discharge planning, documentation… more
- BayCare Health System (Dunedin, FL)
- …regulatory bodies within the area of responsibility + Ensure quality assurance program and utilization review is followed in accordance with Home Care protocol + ... Participates with Case Manager on initial Plan of Care review with a focus on quality, utilization and individual patient care goals **Required Experience:** + 2… more
- CenterWell (Columbia, SC)
- …performance in patient experience, quality of care, clinical outcomes, and avoidable utilization + Periodically review clinician charts to identify opportunities ... of health (SDOH) efforts, improving clinical outcomes and avoidable utilization + Monitor and manage daily patient care and...and monitor clinical & financial performance and metrics + Review clinician schedules and incentive plans to align with… more
- Highmark Health (Buffalo, NY)
- …:** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent assesses ... verifying benefit coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review . Ensures all accurate… more