- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** The role of the Nurse, Quality Review Utilization Management (UM) is to evaluate clinical quality and procedures within ... the Utilization Management (UM) program to maximize efficiency, ensure compliance...achieve optimal performance. We are looking for an experienced clinician in the greater Baltimore metropolitan area who is… more
- Actalent (Deland, FL)
- …hospital inpatient and/or ED discharge records, diagnostic and laboratory results for clinician review and treatment follow-up as needed. Essential Skills + ... perform quality team-based patient care under the direct supervision of a clinician . This includes both clinical and administrative functions to promote health and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... health care services, application of criteria to ensure appropriate resource utilization , identification of referrals to a Health Coach/case management, and… more
- Omaha Children's Hospital (Omaha, NE)
- …Therapist serves as a licensed clinician responsible for managing the utilization review and authorization process for patients receiving care within the ... or inpatient care). Required + 1 year Prior experience in utilization review , case management, or managed care preferred. Preferred **Skills and Abilities**… more
- UPMC (Pittsburgh, PA)
- …of medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... the Quadruple Aim of better health, better care, lower costs, and higher clinician satisfaction. The role is primarily working with health plan Medicare (including… more
- University of Colorado (Aurora, CO)
- …experience. **Professor:** + 7+ years of experience **Preferred Qualifications:** + Master Clinician skills + A publication record in some field of Cardiology **Key ... a Division "operations playbook"o **Access/Scheduling:** Optimize template design, room utilization , referral standards, subspecialty triage, new/return ratios, cancellation/no-show reduction,… more
- Garnet Health (Harris, NY)
- …Manager for the detox patient on the medical floor assuring discharge planning, utilization review , and insurance approval. At Garnet Health, we are committed ... organize/prioritize accordingly, and implement evidence based care. Social Work Clinician /Case Manager - primary role is to provide psychiatric/detox emergency… more
- Albany Medical Center (Albany, NY)
- …a changing environment. + Basic knowledge of computer systems with skills applicable to utilization review process. + RN - Registered Nurse - State Licensure ... works proactively with the Quality Improvement Teams, patient care standards, and utilization management to coordinate the appropriate use of resources to achieve… more
- Sharp HealthCare (San Diego, CA)
- …correct billing codes and modifiers as appropriate.Demonstrate competency in utilization of computer applications including RIS, PACS, voice recognition, ... prescription).* Accurately associate the patient to their images and ordered procedure. Review the reason for the procedure and appropriateness of exam.* Escalate… more
- Stanford University (Stanford, CA)
- …utilization . Additionally, the study will assess patient, caregiver, clinician , and site-related factors influencing the intervention's acceptability and ... aimed at improving patient activation, shared decision-making (SDM), and clinician -patient communication among low-income and minority patients with metastatic… more