- Novo Nordisk Inc. (New Orleans, LA)
- About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... and developing and implementing regulatory strategies with the FDA to providing medical education and collecting data to support efficacy and new product… more
- Fresenius Medical Care (Fitchburg, WI)
- …communicated to and implemented by the facility staff. Maintains integrity of medical records and other FMS administrative and operational records. Complies with all ... renal team. Communicates changes in patient status regarding clinical, insurance, travel and transportation issues to the disease management company. Maintains… more
- Fresenius Medical Care (Greensboro, NC)
- 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 ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages… more
- Integrated Data Services (El Segundo, CA)
- …and financial management system Provide support and assistance in the expert utilization of the Comprehensive Cost and Requirement System (CCaR) and all its ... use of the system Serve as the liaison between different financial systems Review and verify the integrity/accuracy of data downloaded and inputted into the system… more
- Unknown (Buffalo, NY)
- …work effectively within a union environment and is adept at partnering with utilization review , revenue cycle, and clinical leadership to drive operational ... and at least 10 years of care management or utilization management experience in a hospital or ambulatory setting....the organization. Hiring Manager Title System Chief Nurse Executive Travel Percent Less than 10% Functions Medical … more
- Unknown (San Francisco, CA)
- …review of health pharmacy and workers compensation claims. state and federal level external review nurse review and precert medical director review ... Vice President of Sales, Strategic Accounts About the Company Tech-enabled utilization management company specializing in expert clinical reviews Industry Hospital &… more
- Unknown (Philadelphia, PA)
- …plan replacement medical networks care management & navigation utilization review disease management data transparency market-sensitive repricing payment ... Held Founded 2004 Employees 501-1000 Categories Insurance Specialties bill review out-of-network repricing primary ppo and alternative repricing administration edi… more
- Unknown (Waco, TX)
- …departments, including accounting, reimbursement, managed care, health information, and utilization review . This executive role involves close collaboration ... hospital health system technology service center home health nursing health clinics and medical Business Classifications B2C About the Role The Company is seeking a… more
- Crossing Minds Recruiting (Paris, TX)
- …familiarity with real-time APIs and CDPs US Employee Benefits: 75% coverage on Medical , Dental, and Vision insurance. As well as 100% coverage on Basic Life! ... Company shutdown from 12/24 - 01/01 Professional education opportunities Voluntary Travel Policy Visa support, if needed Canadian Employee Benefits: HSA $2500/… more
- Five Star Franchising LLC (Denver, CO)
- …the business modelincluding operations, sales, marketing, customer service, and CRM utilization . In addition, this position supports vendor program management by ... compliance, and performance improvement. ? Conduct regular calls and check-ins to review business progress and key performance metrics. ? Consult with franchisees on… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Huron Consulting Group (Chicago, IL)
- …Management is responsible for planning, organizing, developing, and directing implementation of the Utilization Review Plan and the overall operation of the ... and deliver better consumer outcomes. Health systems, hospitals and medical clinics are under immense pressure to improve clinical...+ Staff Acquisition and Support: Leads and manages the utilization review staff and function for the… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and… more
- Katmai (Fort Carson, CO)
- …access to care standards for appropriate utilization of services. Perform utilization management/ review for medical necessity for specialty referrals and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization...Working knowledge of EHR Genesis desirable. + Knowledge of Medical Terminology. **WORK** **SCHEDULE** Full-time. May be required to… more
- LifeCenter Northwest (Bellevue, WA)
- …Salary Position Type Full Time Description and Qualifications The Director, Organ Utilization (Director), is responsible for overseeing the processes and teams that ... and executes strategies to improve organ allocation strategy and organ utilization , collaborates closely with transplant programs and the surgical recovery team… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... influence stakeholders and networks of healthcare professionals by promoting effective utilization management strategies. Reviews and analyzes medical records,… more
- State of Indiana (Indianapolis, IN)
- …The role of Utilization Management Manager oversees the integration of utilization review , clinically appropriate care and risk management for the purpose ... Utilization Management Manager Date Posted: Nov 30, 2025...paid to thousands of service providers ranging from major medical centers to a physical therapist working with a… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Humana (Lincoln, NE)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization … more
