- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and performance monitoring, oversees all Workers' Compensation (WC) Case Management and Utilization Review (UR) Programs. + Collaborates with the Chief Medical ... for the Casualty and Clinical Services departments which in turn includes Utilization Management, Case Management and Population Health divisions. The position can… more
- CenterWell (Atlanta, GA)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff documentation… more
- Sharp HealthCare (San Diego, CA)
- …when not in use.Is knowledgeable of current laws and regulations regarding Utilization Review and Discharge Planning.Morning arrival time insures orderly ... + Data collectionParticipates in data and statistics collection as requested by Utilization Review , Service Line and Quality Improvement Committees. + Denial… 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 ... Minnesota Position Title: Care Advocacy Case Manager RN - Bilingual Spanish Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of… more
- Veterans Affairs, Veterans Health Administration (Chico, CA)
- …not limited to the following: Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules are ... 04:30pm (PST) Virtual: This is not a virtual position. Remote : This is not a remote position....delivery model. Coordinates with the patient care team to review clinic [appointment availability] ( utilization ) to ensure… more
- Albany Medical Center (Albany, NY)
- …Licensure, Certification & Registration: + Must hold a current NYS Registered Nurse license. Experience: + 7-10 years of experience in nursing, involving ... on-site as the work cannot be done from a remote location. + All job requirements listed indicate the...changes in work efficiently and effectively. Support implementation and utilization of clinical nursing research. Promote the use by… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …Minnesota Position Title: Behavioral Health Care Advisor- Substance Use Disorders Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of ... events to engage with members. Required Skills and Experience * Registered Nurse with Psychiatric experience or Behavioral Health Professional that is Clinician… more
- CommonSpirit Health (Centennial, CO)
- …as a Registered Nurse . 3 years with progressive experience in utilization review , preferred. Prior experience writing clinical denial appeal letters ... indicated through research and coordination of completion of medical records and utilization review processes. Identifies areas for documentation and/or process… more
- Veterans Affairs, Veterans Health Administration (Reno, NV)
- …aligned care team). The Advanced MSA coordinates with the patient care team to review the clinic utilization by using various reports (eg, Clinic Utilization ... of medical clinicians across multiple disciplines (eg medical doctors, nurse practitioners, physician assistants, psychologists, psychiatrists, social workers, clinical… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …for opportunities to educate, support, coach, coordinate care and review treatment options, through collaboration with providers and community-based resources. ... consistent and quality health care services. Examples may include: Utilization Management, Quality, Behavioral Health, Pharmacy, Registered Dietitian and Respiratory… more