- UCLA Health (Los Angeles, CA)
- …external, to assist patients with discharge/post hospital care + Interact closely with Utilization Review and Patient Business Services to ensure correct and ... + Working knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up + Working knowledge… more
- Centene Corporation (Tallahassee, FL)
- …providers on the health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality Improvement ... pharmacy calls regarding the prior authorization and formulary process + Perform review of pharmacy and override process in compliance with pharmaceutical related… more
- Penn Medicine (Philadelphia, PA)
- …and being a strong patient advocate. The case manager conducts utilization management activities, communication with insurers, team, and physician advisor. Discharge ... quality data collection and risk management referral. + Responsibilities: Utilization management activities: monitor appropriate use of internal resources,… more
- Pomona Valley Hospital Medical Center (Pomona, CA)
- …education necessary to meet licensure requirements. One year experience in Utilization Review or Case Management discharge planning, current knowledge/use ... vital role within the Case Management Department. The LVN within the Utilization Management team collaborates closely with Case Managers, support staff, insurance… more
- Catholic Health Initiatives (Omaha, NE)
- …regulations pertaining to their practice. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** Graduate of an ... multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria.… more
- Atlantic Health System (Florham Park, NJ)
- …plan, including transfer eligibility, level of care, resource prioritization & utilization , timely acceptance, and appropriate priority and mode of transport. + ... appropriate transport priority and mode, while considering appropriate resource utilization and timeliness of transfer. + Communicates transport information to… more
- Intermountain Health (Dover, DE)
- …patients and/or patient's family, caregivers, and/or legal representatives socio-economic review and screening to support coordination of care. Plans interventions ... team to provide care coordination for preventative care and utilization mitigation. Identifies appropriate resources, including transportation, housing, healthcare,… more
- Catholic Health Initiatives (Omaha, NE)
- …regulations pertaining to their practice. Performs other duties as assigned, including utilization review as necessary. **Job Requirements** Graduate of an ... multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria.… more
- City of New York (New York, NY)
- …Budget Helpdesk. Direct providers to the Helpdesk e-mail. - Assist with MWBE Utilization submissions in DYCD Financial. Review , reject, and approve submissions ... by DYCD. - Assist unit staff with conducting Desk Review , Mid-Year, and Closeout EMTs - Assist unit staff...are due. - Assist with PASSPort submissions and rejections. Review documents with program managers for final review… more
- St. Bernard's Medical Center (Batesville, AR)
- …Case Management/Social Work staff and Administration to assure insurance process and utilization review flows smoothly. Maintain good relations with clinics and ... insurance plans. Must be able to converse with insurance company and review agency representatives and possess communication skills to provide needed information in… more