- St. Luke's Health System (Meridian, ID)
- …skills **Responsibilities:** + Serves as an initial escalation point for review of system enhancement requests impacting a single application to ... validateappropriateness for escalation to build/governance review . + Serves as project/enhancement request facilitator for enhancement and build requests as they… more
- Prime Healthcare (Elgin, IL)
- …and supervision to case managers, social workers, case management coordinators/discharge planners, utilization review coordinators and utilization review ... effective outcomes and to perform a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …is a critical component of BCBSMN Care Management team as the primary clinician providing condition and case management services to members. The position exists to ... MN license and with no restrictions or Behavioral Health Professional that is Clinician licensed for independent practice with one or more of the following licenses… more
- Penn Medicine (Philadelphia, PA)
- …and/or caregiver(s). For clinical-related questions and inquiries identify the appropriate clinician and/or clinical department and ensure that all of the patient's ... addressed in a timely manner. In collaboration with a clinician , ensure that all medical records are received and...and have been translated into English so that case review by clinical staff can proceed. Assist with the… more
- Elevance Health (Houston, TX)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... + ACMP experience is preferred. + Medical Management experience is preferred, + Utilization Review experience is preferred. + Knowledge of the medical management… more
- Catholic Health Initiatives (Chattanooga, TN)
- …through work that involves maximizing clinical operations, improving clinician alignment and satisfaction, and leading evidence-based programs, practices, ... market Medical Staff Office director to lead credentialing, privileging, and peer review . + The MCMO sets strategic direction for the above-mentioned areas, which… 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 ... a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members. Your Responsibilities *… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …and their family to avoid unnecessary hospitalizations and emergency department utilization , optimize site of care whenever possible, and ensure evidence-based ... position focuses on members going through the transplant experience. This clinician receives referrals and leverages clinical and condition pathway knowledge for… more
- OptiMindHealth (Cambridge, MA)
- …Part-Time FLSA Status: Non-Exempt Location: Cambridge, MA Join a leading clinician -led behavioral health company today! OptiMindHealth (OMH) is expanding and seeking ... Discuss the possible overlap in our offerings and needs to stakeholders, review our specialty areas and note our differentiating characteristics. 3. Complete and… more
- Humana (St. Paul, MN)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... member and provider issues. Coordinates the clinical resolution with internal/external clinician support as required. Documents and summarizes to all parties… more