- Amergis (Waldorf, MD)
- …and referrals for psychosocial needs + Participates in Quality Assurance and Utilization Review activities, as directed + Empowers patients in decision-making ... utilization of resources, service delivery, and compliance with medical regime. Essential Duties and Responsibilities: + Performs and...pertinent to patient's needs/goals + Partners with the Program Director in development and review of the… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …to adjudicate these requests. At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical ... tasks as assigned by the Associate Medical Director of the Physician Psychologist Review Unit...order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician… more
- MVP Health Care (Tarrytown, NY)
- …coordination of quality cost effective care. + The Case Manager will also monitor and review cases with the Medical Director to ensure appropriate outcomes. ... (eg, NCQA), including documentation and reporting. + Cost Management: Monitor service utilization to maintain cost-effectiveness and manage Medical Loss Ratio… more
- Maersk (Norfolk, VA)
- …in order to service the vessel with timely attention and efficiency * Routinely review the vessel safety committee meeting and initiate follow up. Utilize support in ... maintenance programs; and work orders. * Overall supervise the utilization of Ship Manager processes and functionalities. * As...Ensure cost spending decisions are made with a continuous review of the Budget * Review Cost… more
- Elevance Health (Las Vegas, NV)
- …+ May process a medical necessity denial determination made by a Medical Director . + Develops and fosters ongoing relationships with physicians, healthcare ... initiatives to improve the efficiency and effectiveness of the utilization reviews within the medical management processes....a minimum of 6 years of clinical experience and/or utilization review experience. + Current active, valid… more
- BrightSpring Health Services (Dunbar, WV)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
- CenterWell (Anderson, SC)
- …active participant and leads the care team through daily huddles. + Helps Associate Medical Director (AMD), Physician and Center Administrator in setting a tone ... accordance with standards of care. + Follows level of medical care and quality for patients and monitors care...Leadership. + Meets with AMD about quality of care, review of outcome data, policy, procedure and records issues.… more
- United Airlines (Dulles, VA)
- …and presentation decks on project progress, key metrics, and resource utilization for management review and decision-making . **Stakeholder Communication** ... managing their projects as well as supporting the Planning and Development Director and the Business Service Team in effectively managing project portfolios, labor… more
- HCA Healthcare (Houston, TX)
- …and retirement of our colleagues. The available plans and programs include: + Comprehensive medical coverage that covers many common services at no cost or for a low ... health coverage as well as free telemedicine services and free AirMed medical transportation. + Additional options for dental and vision benefits, life and… more
- Houston Methodist (Katy, TX)
- …Audit, Business Practices, Health Information Management, Patient Access Services, and Utilization Review as needed to ensure operational billing compliance ... areas of Revenue Cycle, to include but not limited to: medical coding, insurance billing, collections, patient account resolution, appeals/denials, customer service,… more