- MTC (San Diego, TX)
- …Functions:** 1. Performs complex technical assistance work; implements quality assurance utilization review procedures; and responds to inquiries regarding ... technical program and administrative rules, regulations, policies, and procedures. 2. Assists in monitoring, reviewing, interpreting, and evaluating quality of services; assists in compiling and analyzing data and preparing reports; and makes recommendations… more
- Intermountain Health (St. George, UT)
- …+ Case Management Certification + Demonstrated experience in case management, utilization review , value-based care, and/or discharge planning. + Basic ... computer skills, including proficiency in word processing and spreadsheet software. Intermediate knowledge of word processing and Excel software. **Physical Requirements:** **Physical Requirements** + Ongoing need for employee to see and read information,… more
- Catholic Health (Kenmore, NY)
- …(2) years acute care and/or community health nursing + Preferred prior insurance /managed care/ utilization review experience in the role of a Case Manager or ... Disease Manager, Population Health, Discharge Planning or Chronic Care Manager KNOWLEDGE, SKILL AND ABILITY + Possesses case management skills critical to working on an interdisciplinary team + Has a good understanding of the Social Determinants of Health… more
- Accura Healthcare (Shell Rock, IA)
- …personalized assessments for use in the evaluation of quality of care and utilization review for the purpose of clinical reimbursement. Confer with physicians, ... nurses, and other health personnel to ensure complete, current, and accurate medical records. QUALIFICATIONS: + Hold current Registered Nurse (RN) license with applicable state, without restrictions, and/or ability to obtain a state-specific license. +… more
- State of Georgia (Fulton County, GA)
- …or licensed/certified professional in a related field or setting . Experience in utilization review and/or quality assurance in a healthcare setting . Experience ... in conducting assessments and evaluations based on regulations, legal requirements and/or recognized accreditation standards . Experience in performing investigations and audits related to allegations that consist of gathering the appropriate information,… more
- Bon Secours Mercy Health (Greenville, SC)
- …patient care experience as an RN (required) Experience with discharge planning or utilization review (preferred) As a Bon Secours Mercy Health associate, you're ... part of a Mission that matters. We support your well-being-personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. **What we offer** + Competitive pay, incentives, referral bonuses and 403(b)… more
- Penske (Clackamas, OR)
- …on location of accounts, volume, costs, customer requirements and private fleet utilization . Review daily orders for additional private fleet opportunities based ... on above requirements. **Schedule** : Tuesday - Saturday 11:00 AM - 8:00 PM (Hours may vary depending on business needs) **Salary** : $77,969 - 91,950 - Position is bonus eligible up to 12% of the base salary **Benefits:** Our excellent benefits plan keeps… more
- Banner Health (CA)
- …benefits, health and dental plan inquiries, and services of staff such as utilization review , prior authorization, billing and contract management. 6. Services ... inbound and outbound customer and staff communications for all facilities in the states in which they operate. Works with various departments and staff to provide accurate managed care information. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent… more
- Arkansas Children's (Little Rock, AR)
- …concerning food drug interactions and therapeutic drug monitoring. Assists in drug utilization review activities. 11. Places order with local wholesaler for ... medications and supplies and back orders directly with manufacturer for items in short supply immediately when local wholesaler unable to supply. 12. Assures that substitution items are obtained when original item unavailable and substitution items are checked… more
- Alameda Health System (Alameda, CA)
- …and a resolution is initiated and presented weekly at Medicare or Utilization Review meetings. **MININUM QUALIFICATIONS** : Education: Graduate of accredited ... school of nursing. Minimum Experience: Minimum one year clinical experience in a hospital, long term care facility, or other healthcare related facility. Preferred Experience: Previous experience as an MDS Coordinator; including completing Minimum Data Set… more