- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges follow up care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... provide requested clinical and psychosocial information to assurereimbursement. + Utilization Review -- Reviews prospectively, concurrently and retrospectively… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …bundling edits, and recommend action steps regarding code configuration issues, annual utilization and review analysis. + Maintain current knowledge of coding ... procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy development… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to...patients who were readmitted within thirty days. Documents over utilization of resources and services. + All Medicare cases… more
- COOLSOFT (Raleigh, NC)
- …the Pharmacy Business team for Clinical policies and Prior Authorizations, Drug Utilization Review (DUR) and pharmacy lock-in related processes, Behavioral ... areas, including. o Clinical policies and Prior Authorizations. o Drug Utilization Review (DUR) and pharmacy lock-in related processes o Behavioral health, and… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and aftercare… more
- Battelle Memorial Institute (Norfolk, VA)
- …within legal and professional parameters + Knowledge and skill in using pre-established utilization review criteria to recognize and report actual or potential ... will support positive programs for equal treatment of all staff and full utilization of all qualified employees at all levels within Battelle._ The above statements… more
- Emanate Health (Glendora, CA)
- …for performing clinical consults according to pharmacy guidelines and conducting ongoing drug utilization review to promote effective, safe and efficient use of ... medications. Supervises technicians to optimize workflow and resource utilization . Actively participates in CQI activities. **Job Requirements** **Minimum Education… more
- Somatus (Mclean, VA)
- …Product Areas:** Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review **Product Management** + **Build** business cases to secure ... development funding. **Revenue and Expense** + **Own** revenue and expense targets. + Integrate product portfolio into recurring revenue forecasts. + **Maintain** systems to monitor risks and opportunities. + Apply financial analysis to optimize revenue. +… more
- GCI Communication Corp (Anchorage, AK)
- …and utilization to meet business and operational needs. + Facilities Utilization & Performance: Regularly review network facilities utilization and ... the software and firmware upgrade/patch process, minimizing operational disruption. + Review and analyze the effectiveness of implemented network and service… more
