- Prime Therapeutics (Boise, ID)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations etc.); compile ... administering the annual conflict of interest process, or completing regular review of standard operating procedures and policies; may develop annual revision… more
- Prime Therapeutics (Columbia, SC)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- State of Connecticut, Department of Administrative Services (Suffield, CT)
- …+ Prepares and/or reviews reports, medical records and correspondence; + Perform utilization review and management functions; + Attends court hearings as ... training are most aligned with the role. To prepare, review this helpful Interview Preparation Guide to make the...recruitment updates, please check your Personal Status Board and review our Frequently Asked Questions. If you have additional… more
- Bon Secours Mercy Health (Springfield, OH)
- …discharged from the program + Provide accurate and timely documentation of services + Utilization review of assigned clients + Provide education to community and ... treatment planning, clinical treatment, group therapy, intensive outpatient treatment, case review , discharge planning and crisis intervention and other duties as… more
- Sevita (Indianapolis, IN)
- …emergency procedures; participate in emergency coverage system; and oversee Utilization Review , Quality Assurance, investigations, and internal evaluations. ... and similar actions. Resolve employee problems within position responsibilities. + Review each individual's treatment plan and progress of goals and objectives;… more
- Insight Global (Brookfield, WI)
- …technology implementations. * Deep knowledge of medical cost containment strategies (bill review , utilization review , provider networks, nurse case ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- Immigration and Customs Enforcement (Washington, DC)
- …of command. Perform other duties and responsibilities as assigned. 16. Utilization review /management for inpatient behavioral health hospitalization for IHSC. ... and transfer to an IGSA or IHSC-staffed facility with increased BH resources. Review and adjudicate requests for outside mental health services for detainees in ICE… more
- Elevance Health (Indianapolis, IN)
- …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 reviews with attending physicians or other providers to discuss review determinations, and patients' office visits with providers and external physicians.… more
- Providence (CA)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- HCA Healthcare (Austin, TX)
- …and retrospective review of patient medical records for purposes of utilization review , care coordination compliance with requirements of external review ... agencies including government and non-governmental payers and quality assurance. Promotes a cooperative and supportive relationship as liaison with patient, family, facility staff, physician; funding representatives and community agencies. Ensure continuity… more