- 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
- UnitedHealth Group (Seattle, WA)
- …certification 3+ years of experience working in acute care 1+ years of care management , utilization review or discharge planning experience HMO experience ... line with established disease management and care management programs in order to optimize clinical ...thorough understanding of the cost consequences resulting from Care Management decisions through utilization reports and systems… 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
- Ochsner Health (Gretna, LA)
- …social services, home health, managed care, care management , case management or utilization review .CertificationsRequired - Current registered nurse ... leadership to review processes with the goal of improving the clinical experience for referred patients and the referring physician.Adapts behavior to the… more
- Health eCareers (Los Angeles, CA)
- The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization ... to the Senior Medical Director of Case Management and Utilization Management .HeC_JGEducation and Clinical Documentation Improvement: Supports education… more
- Novo Nordisk Inc. (San Diego, CA)
- …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
- 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
- buyer (Tinton Falls, NJ)
- …Meetings, Utilization Review , and Performance Improvement/Risk Management /Safety (PI/RM/S) Committee.Reviewing clinical outcomes to ensure that we ... key leadership role as our Assistant Director of Nursing, where you'll drive clinical excellence and impactful outcomes across our Assisted Living community. Join a… more
- University Health (San Antonio, TX)
- …years of recent, full-time hospital experience preferred. Work experience in case management , utilization review , or hospital quality assurance experience ... patient advocate to identify and communicate healthcare needs. Works collaboratively with clinical staff, clinic leadership, and outside agencies in an effort to… 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
- TrackFive (Miami, FL)
- …all needs (ie, physical, psycho-social, financial). Participates in IDT rounds, Conducts utilization review , evaluates clinical information, and communicates ... Review Plan and managed care contractual agreements. Submits clinical information to insurance companies to ensure all days...understand the medical needs for patients Certification in Case Management , Nursing or Utilization Review … more
- TrackFive (Atlanta, GA)
- …than 3 days of RTOWellstar does not allow block schedulingJob Summary: The RN Clinical Nurse is a proactive member of an interdisciplinary team of licensed and ... others receive individualized high quality, safe patient care. They practice in a clinical environment that is administered by Nurse Managers and other leaders and… 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
- buyer (New York, NY)
- …and appropriate services and other resources to assist in goal achievement. Conduct Utilization Review for designated Case Management members for some ... in a Psychiatric Hospital Inpatient and/or Outpatient experience with both case and utilization management . One-year HARP experience preferred. Field based Case … 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
- 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
