- Appcast (Canton, MA)
- …of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... remote, but Massachusetts RN license required. Job Summary The Clinical Reviewer is a licensed professional -a...a and unrestricted Massachusetts license requiredMinimum of five years clinical experience in utilization management ,… more
- AmeriHealth Caritas Health Plan (Wilmington, DE)
- Role Overview Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... occasional overtime, and weekends based on business needs Responsibilities Conduct utilization management reviews by assessing medical necessity, appropriateness… more
- TrackFive (Houston, TX)
- …with experience in a long-term acute care setting. discharge planning, clinical case management & utilization review Must have Texas RN or multi-state RN ... Hospitals, Health Systems, Laboratories, Pharmaceutical Companies, Medical Device Companies, Clinical Research Organizations, Private Physician Practices, Long and Short-Term… more
- Curative HR LLC (Austin, TX)
- …Contribute to the development, review , and revision of medical policies, clinical guidelines, and utilization management protocols. Participate in ... changes, and industry best practices in utilization management . Champion a member-centric approach while balancing clinical...practice experience. Minimum of 2-3 years of experience in utilization management , medical review , or… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... a difference? The Position Position provides field coaching, mentorship and management to the field-based Medical Liaisons, and develops and implements strategies:… more
- JobAdX (Green Bay, WI)
- …be provided with support and extensive leadership training.About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient ... care is delivered while maintaining clinical operations. As the facility leader, you will be...auditing activities.Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding.Manages clinic… more
- Novo Nordisk Inc. (San Francisco, CA)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... to make a difference? The Position Builds relationships and demonstrates the clinical outcome and benefits of NNI products. Educates and demonstrates the benefits… more
- CareOregon (Portland, OR)
- …Implements and oversees effective systems to ensure access, program integrity, quality of clinical care, utilization management , compliance with OARs and ... delivery system or managed care organization Experience in Medicaid, quality assurance, utilization review , case management , and/or risk adjustment… more
- Novo Nordisk Inc. (East Cleveland, OH)
- …relationships with those individuals Recognize opportunities to productively challenge HCPs clinical management of patients that respects their knowledge and ... assess, create and maintain advocacy of customers aligned to company, brand and clinical goals. The OCS develops local strategies and executes local tactical plans… more
- Novo Nordisk Inc. (Detroit, MI)
- …and insights with target physicians Recognizes opportunities to productively challenge HCPs clinical management of patients that respects their knowledge and ... Sales Representative also assists their target physicians with their local clinical and educational initiatives by coordinating company resources (eg, counterparts,… more
- Vivian (Cambridge, MA)
- …hours per weekShift: 8 hours, daysEmployment Type: TravelPrimary Responsibilities:1. Performs utilization review and discharge planning to inpatient admissions ... Inpatient criteria approved by the MACIPA (risk) and MAH (non-risk) Utilization Management Committees to accurately determine appropriateness for inpatient… more
- Orlando Health (Longwood, FL)
- …services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to the next ... Three (3) years of experience in chronic disease management , care management , care coordination, utilization management , or acute clinical care. more
- University of Maryland Medical System (Baltimore, MD)
- …year of experience in case management and knowledge of payer mechanisms and clinical utilization management is preferred. Two years experience in acute ... patients within an assigned case load for care coordination, discharge planning, and utilization management services Facilitates early referral to high risk case… more
- Integrated Home (Hollywood, FL)
- …organized and interact well with others in any situation Provide updates to Manager of Utilization Management for review What will you come with: State ... reward programs Comprehensive paid training program What will you be doing: As a Utilization Management Nurse, you will ensure that home health care services are… more
- Novo Nordisk Inc. (Olathe, KS)
- …centers, HCPs and other stakeholders in a given geography. Utilizing approved clinical resources to support provider efforts to deliver appropriate care for ... growth of the therapeutic market. This is not a clinical patient-facing role. Relationships The CM Educator is an...range of HCPs and local stakeholders to enhance cardiometabolic management across the territory and region. Additionally, the role… more
- MindMatch (Aiken, TX)
- …in the field of gerontology, the care of women religious and nursing management through literature review and attendance at seminars/workshops. Utilizes good ... professional accountability for competency and growth. The Registered Nurse Clinical Supervisor assists the DON in some administrative duties,...unable to do so. Assists DON in the proper utilization of personnel assigned to the care of retired… more
- University Health (San Antonio, TX)
- …Three years recent, full-time hospital experience preferred. Work experience in case management , utilization review or hospital quality assurance experience ... Works with more difficult/complex patients, promoting the achievement of optimal clinical and resource utilization allocation; facilitates transitions to… more
- Eisai, Inc (Nutley, NJ)
- …regional medical directors and MSL leadership, Publications, Medical Communications, Clinical Development, Biostatistics, Field HEOR, Patient Advocacy, and other ... prepare medical affairs personnel to enter strategic and compliant discussions regarding medical/ clinical data on Eisai products. The AD assumes a leadership role by… more
- UnitedHealth Group (Grand Junction, CO)
- …to work Monday - Friday, 930am-6pm Mountain Standard Time Preferred Qualification: Utilization Management experience *All employees working remotely will be ... a difference? Join us to start Caring. Connecting. Growing together. The Clinical Coordinator is responsible for processing all Behavioral Health and Substance Use… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …need them most, by creating an environment where innovation and chronic disease management drive optimal health outcomes. Are you ready to realize your potential? ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
