- AmeriHealth Caritas Health Plan (Wilmington, DE)
- …to efficiently document and assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... compliance Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment Your career starts now. We are looking… more
- Paul Davis Restoration, Inc. (Jacksonville, FL)
- …of the department and network during a catastrophe event. Position: Full-Service Reviewer Reports to: Review Team Manager Location: Hybrid Essential ... Join Our National Team as a Full-Service Reviewer ! Are you looking to leverage your expertise...large losses of all job types. These reviews include utilization of knowledge of industry standards, carrier guidelines, and… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …and people resources, supporting appropriate use of NNI products and greater utilization of its services Takes a leadership role in coordinating activities at ... health care providers Support appropriate use of NNI products and greater utilization of its services Support representatives in answering physicians questions Works… more
- Integrated Home (Hollywood, FL)
- …and interact well with others in any situation Provide updates to Manager of Utilization Management for review What will you come with: State licensure as ... 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. (San Diego, CA)
- …appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Novo Nordisk Inc. (San Francisco, CA)
- …providers and IHNs Develops appropriate use of NNI products and greater utilization of its services Supports and assists representatives and managers in answering ... sites; ensuring effective coordination and facilitation of studies to ensure timely review , initiation, and completion, as well as publication of study results.… more
- Novo Nordisk Inc. (East Cleveland, OH)
- …sales and marketing resources to expand the breadth and depth of appropriate utilization Novo Nordisks products, consistent with label and company policy Analyze and ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Merck & Co. (Durham, NC)
- …culture by reducing waste and constantly driving continuous improvement. -Responsible to review and approve compliance documents, as per procedures or need.Supply - ... - Responsible for creating and sustaining a highly engaged workforce through utilization of our Company Leadership Behaviors and Inclusion.- Provide coaching on… more
- Eisai, Inc (Nutley, NJ)
- …and MSL managers. Develop congress abstract tracker, assign MSL coverage, review MSL reporting responsibilities, collate and distribute Congress Report, execute pre- ... for internal medical training content. Train new hires on EMAC organization/ utilization .Provide input into and collaborate with regional and global medical leads… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A Bachelor's degree required Master's degree… more
- Novo Nordisk Inc. (Boston, MA)
- …collateral development Achieve or exceed assigned sales objectives through effective utilization of all available resources, strategies and tactics Collaborates with ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A bachelors degree required Minimum five… more
- Novo Nordisk Inc. (Olathe, KS)
- …and adapting to business priorities Educate HCPs to increase product utilization , optimize treatment, and align with evidence-based medicine and guidelines, while ... standing by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A bachelor's or equivalent degree is… more
- American Traveler (Puyallup, WA)
- …experience required, *Healthcare financial and reimbursement knowledge required, *ER and utilization review experience preferred, *BLS not required, *Will not ... consider first-time travelers, *Not suitable for candidates with predominantly pediatric/children's hospital backgrounds, Additional Information *Responsibilities include post-discharge planning and providing community resources, *Breaks are required during… more
- Pharmacy Careers (Orlando, FL)
- Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review ... prescribing trends and propose cost-saving alternatives. Maintain evidence-based formularies across multiple payers. Conduct retrospective DUR and prepare stakeholder reports. Qualifications: PharmD with managed care, DUR, or pharmacy benefit experience.… more
- AltaMed Health Services Corporation (Montebello, CA)
- …The LVN Utilization Management Nurse (UM Nurse) will provide routine review of authorization requests from all lines of business using respective national/state, ... Vocational Nurse. Minimum of 2 years of managed care experience in Utilization Management/prior authorization required. A minimum requirement of a valid BLS… more
- AMN Healthcare (Pleasanton, CA)
- …3+ years of home health since we need someone very well versed in the HH setting to make UM decisions. Quality Coordinator exp CA LIC Preferred Qualifications Prior ... Benefits At AMN Healthcare we take care of our travelers! We offer: Competitive pay rates Free, quality, private housing Medical, Dental, Vision 401(k) and Flex Spending Life Insurance Accident and Short-term Disability Coverage Free Continuing Education Refer… more
- Sonder Health Plans, Inc. (Atlanta, GA)
- …for you to join us. Sonder Health Plans is looking for a full-time Utilization Management Nurse to make sure our health services are administered efficiently and ... complex cases that require additional clinical management support *Conducts initial review of prior authorization or pre-certification requests for determination of… more
- Curative HR LLC (Austin, TX)
- …years of clinical practice experience. Minimum of 2-3 years of experience in utilization management, medical review , or prior authorizations within an insurance ... This pivotal role will be responsible for overseeing and performing utilization reviews, prior authorizations, and making crucial medical necessity determinations.… more
- Kaiser Permanente (Pleasanton, CA)
- …Experience Minimum three (3) years of home care experience or quality utilization review experience. Education Bachelors degree in clinical related field ... Description: Job Summary: Coordinates quality, utilization and risk management activities for the Home Care Agency; provides technical, educational, consultative,… more
- Valley Health System (Paramus, NJ)
- …/ LOS management. Accountable for directing the day-to-day operations for Concurrent Utilization Review processes for Medicare, Medicaid, Managed Care and ... CPUR, CPHQ or CCM preferred. Minimum 5-7 years experience in utilization management, quality improvement or a related area. Experience Demonstrated managerial… more
