- Blue Shield of California (El Dorado Hills, CA)
- … clinical criteria across multiple lines of business. The Behavioral Health Utilization Management , Consultant (Lead), will report to the Manager ... Job Description Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective,...expert for the BH UM team as they conduct clinical reviews of mental health and substance use authorization… more
- UnitedHealth Group (Minnetonka, MN)
- …completing, and communicating the results of studies evaluating the performance of utilization management programs Use SAS/SQL to construct claims-based datasets ... and interpret key drivers of health care trends (ie medical cost trends, utilization , etc.), utilization management program performance, and potential… more
- NFP (Chesterfield, MO)
- …around the globe address their most significant risk, workforce, wealth management and retirement challenges through custom solutions and a people-first approach. ... To learn more, please visit: https://www.NFP.com. Position Overview: The Pharmacy Benefits Consultant serves as a critical member of the consulting team. The … more
- Legend Biotech USA, Inc. (Baton Rouge, LA)
- …Affairs team. Direct education for healthcare professionals treating oncology patients on clinical data, adverse event management , and mechanism of action for ... between investigators and members of the Legend Biotech Medical Affairs and Clinical Development teams; Addressing AE management and education as… more
- Talent Connect Now (San Diego, CA)
- …of participant care (resources), clinical outcomes, performance improvement, and Utilization Management (UM). Designs and conducts quality projects and stays ... policies and procedures for appointment of medical staff and review of clinical privileges. PRESCRIPTION DRUG PLAN (MEDICATION MANAGEMENT ) Collaborates with the… more
- Banner Health (Mesa, AZ)
- …comprehensive patient education to improve medication compliance and promote patient self- management skills. Must possess clinical acumen and skills necessary ... pharmacy collaborative practice protocols, to optimize patient regimens and improve clinical outcomes. Ensures utilization of appropriate and cost-effective… more
- Duke Health (Durham, NC)
- …draining wounds, or incontinence, throughout the organization. This includes the utilization of clinical expertise to provide preoperative and postoperative ... within and across departments that promote patient safety, culturally competent care, and clinical excellence *Serves as a resource and consultant to nursing… more
- HCA Healthcare (Las Vegas, NV)
- …in-service programs to facility medical staff regarding clinical resource management , appropriate documents standards, utilization and quality issues, and ... utilization review/ management . Consults with facility-level staff regarding delegated utilization management and disease management operations under… more
- Advocate Aurora Health (Oak Lawn, IL)
- … Operations, site leadership and other key stakeholders. Serves as an internal consultant on Care Management opportunities. Acts as an expert resource for ... 11224 Advocate Aurora Health Corporate - IL Inpatient Care Management Operations Status: Full time Benefits Eligible: Yes Hou...Typically requires 5 years of experience in a relevant clinical setting. Includes 1 year of supervisory experience in… more
- Trinity Health (Silver Spring, MD)
- …appropriate utilization /level of care (LOC), length of stay (LOS) management , patient flow/throughput management , appropriate clinical documentation, and ... LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities,...planning (DP) advise and quality issues. Functions as a consultant and resource to other Physician Advisors and primary… more
