- SpartanNash (Wyoming, MI)
- …by the Company. + Generate various reports (ie store sales, prescription drug utilization , inventory, etc.) and review with pharmacy operations to assist stores ... Summary:** This role is responsible to participate in the review and compliance of pharmacy operations and provide training...personnel. **Here's what you'll do:** + Participate in the review and compliance of pharmacy operations. + Conduct store… more
- US Tech Solutions (Columbia, SC)
- …effective outcomes. **Responsibilities:** + Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Penn Medicine (Philadelphia, PA)
- …quality data collection and risk management referral. Responsibilities: + Utilization management activities: monitor appropriate use of internal resources, ... and timely patient flow elevates issues appropriately Enters all review activity in Canopy concurrently Accounts for all patient...Accounts for all patient days accurately in Canopy Enters review indicating "pending" status of case if outcome not… more
- Blessing Hospital (Quincy, IL)
- …principal liaison between emergency services, surgical services, nursing, finance, physicians, utilization review , and medical records to ensure appropriate bed ... ON RELEVANT EXPERIENCE COMPETITIVE BENEFITS Click here (https://www.blessinghealth.org/sites/default/files/users/user15/HR\_2023\_Total\_Rewards\_Guide.pdf) to review our complete Total Rewards Guide. + Retirement +… more
- Veterans Affairs, Veterans Health Administration (Glendale, CO)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... CONTINUOUS ANNOUNCEMENT. Applications will be accepted on an ongoing basis. Initial review will be conducted approximately 12/9/25. Then, eligible applicants will be… more
- UNC Health Care (Raleigh, NC)
- …5. Collaborates with the Operations Manager to select patients for audit review . Reviews patient records to determine appropriate utilization . 6. Coordinates ... 3. Reviews and evaluates patients' medical records. Selects specific topics for review such as problem procedures, drugs, high volume cases, high-risk cases, or… more
- Veterans Affairs, Veterans Health Administration (Boise, ID)
- …intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, ... community care regulations, and Veterans Health Administration (VHA) standards and guidelines. Uses nursing knowledge and systems theory to assess, organize, facilitate, and guide Veterans through their full range of care options including internal/direct care… more
- Stanford Health Care (Palo Alto, CA)
- …and Lawson use in regards to their level of access and job code(s) + Review demand patterns, days of inventory on hand (DIOH) and inventory turns to establish ... cost across all supply locations + Develop reports based around inventory par location utilization and metrics to report on daily, weekly, & monthly + Monitor all… more
- US Tech Solutions (Boston, MA)
- …be directly associated with incoming referrals and authorizations for the utilization component of medical management. **Key Responsibilities/Duties - what you will ... an event or transaction by lines of business for the UM teams to review and decision requests + Contacts provider offices for further details on clinical… more
- Genesis Healthcare (Albuquerque, NM)
- …including case-mix, OBRA and OSRA required assessments. *Perform concurrent MDS review to insure appropriate RUGs category is achieved through the capture ... required. *Experience with Medicare/Medicaid reimbursement, MDS completion, clinical resource utilization and/or case management is highly desirable. *Must maintain… more