- Humana (Jefferson City, MO)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Jefferson City, MO)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... To provide leadership to integrated inpatient teams; assists Director in the management of department; including personnel and fiscal management and development… more
- CenterWell (Jefferson City, MO)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- Evolent (Jefferson City, MO)
- …Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. Job ... Reviewer you will be a key member of the utilization management team. We can offer you...standards in the participating provider network and for other clinical staff . + Conducts regular audits, as… more
- HCA Healthcare (Kansas City, MO)
- … staff and patients** + **Actively participate in pharmacy clinical services such as drug consults, nutrition support, pharmacokinetics, anticoagulant monitoring, ... defined by Pharmacy Leadership.** + **Participate in the antimicrobial management and other clinical programs** + **Document...+ **Active participation in at least one nursing, medical staff , quality, or pharmacy committee. The Clinical … more
- Humana (Jefferson City, MO)
- …Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Highmark Health (Jefferson City, MO)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Deloitte (Kansas City, MO)
- …plans for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education ... clinical registered nurse, physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG… more
- Blue KC (MO)
- …or special consideration (eg, benefits) should be made. + Participate in existing client utilization and renewal meetings or tell our clinical value story as ... engagement, and interventions for cost containment. + Regular communications with Blue KC Clinical Operations staff to ensure identified members are addressed as… more