- LA Care Health Plan (Los Angeles, CA)
- …by health risk assessment (HRA), risk stratification, predictive modeling, provider's utilization review vendors, members, Call Center, claims staff, Health ... Homes Program (HHP) eligibility or other data sources to determine whether care management intervention is necessary to meet the member's needs. Conducts Care Management services for the most complex and vulnerable members including: engaging in member centric… more
- Comunilife (Bronx, NY)
- …Program Director to assure quality program service delivery and participates in Utilization Review /Quality Improvement process. + Participate in case finding, ... networking and outreach activities to increase clients' enrollment. + Works closely with agency's program directors to ensure assure continuity of care within the organization. Qualifications Education and Experience Requirement(s) + Associate's Degree in… more
- Fairview Health Services (Princeton, MN)
- …may include prior authorizations, vacation supplies, dose changes, price check and drug utilization review . + Process new and refill prescriptions in the ... computer system quickly and accurately; including entering refill authorization requests and entering and calculating complex prescriptions such as compounds and injectables. + Demonstrate comprehensive knowledge of the computer system. Utilize the reporting… more
- City of New York (New York, NY)
- …vetting energy savings calculators and reviewing supporting audits, as needed; (2) utilization and review of existing tools, such as energy calculators, ... entities to identify and develop energy efficiency projects through the review of Energy Efficiency Reports (EERs), Energy Master Plans, electrification… more
- AnMed Health (Anderson, SC)
- …necessity review , continued stay/concurrent review , retrospective review , bed status management, resource utilization management, regulatory compliance, ... assigned utilization management functions daily: initial, concurrent and retrospective review of the medical record with speed and accuracy for all required… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position Type: Full ... the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically… more
- Evolent (Annapolis, MD)
- …mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Utilization … more
- CVS Health (Baton Rouge, LA)
- … Utilization Management Nurse Consultant (UMNC) for NICU Concurrent Review conducts high-acuity, timely, and comprehensive clinical reviews for neonatal intensive ... ensuring data integrity and compliance. * Participate in quality improvement, policy review , and education related to NICU and special populations utilization … more
- Ochsner Health (Jefferson, LA)
- …relationships, contract management, standardization and consolidation processes and utilization analysis. Reviews, analyzes, negotiates, and develops contractual ... product change and serves as an internal advocate of product standardization/ utilization initiatives; coordinates new product introduction and overall product change… more
- Hartford HealthCare (Southington, CT)
- …patient care decisions to support optimal clinical and operational outcomes. They review visit utilization for care appropriateness and collaborate with ... providing recommendations to ensure quality and reliability. Reviews visit utilization for appropriate patient care, collaborates and consults clinicians on… more