- Centene Corporation (Jefferson City, MO)
- …28 million members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various ... the operations of utilization management, reconciliation coordination, concurrent review ( telephonic and on-site), specialty therapy programs and other… more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.… more
- ChenMed (New Orleans, LA)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provides telephonic or outpatient visits to patients at high-risk for...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- CommonSpirit Health (Houston, TX)
- …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more
- ChenMed (Houston, TX)
- …years' clinical work experience required. + A minimum of 1 year of utilization review and/or case management, home health, discharge planning experience ... engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family… more
- ChenMed (Lakeland, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provide telephonic or outpatient visits to patients at high risk...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- Sharecare (Columbus, OH)
- …for supporting goals and objectives of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, ... orientation and to take the pre and post-test to review competency during orientation. Yearly competency test is required...with a preference for dietary coaching experience in a telephonic environment + The successful candidate must possess a… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
- Elevance Health (Houston, TX)
- …TX The **Manager Behavioral Health Services** is responsible for Behavioral Health Utilization Management (BH UM), or Behavioral Health Case Management (BH CM) or ... assist with implementation of cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues. + Hires, trains, coaches,… more
- Highmark Health (Columbus, OH)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- AON (Philadelphia, PA)
- …delivery, and profitability. + Meet or exceed assigned billable hours and utilization goals. + Communicate and collaborate with manager and Account Executives to ... relating to services rendered by carriers and/or TPAs to include the review and revision of account instructions, addressing client service concerns and negotiating… more
- CVS Health (Trenton, NJ)
- …English **Preferred Qualifications** + Crisis intervention skills + Managed care or utilization review experience + Case management and discharge planning ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. + The… more
- Albany Medical Center (Albany, NY)
- …the RN may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's specific care plan ... results in EHR * Performs venipuncture per order of MD/APP * Performs review and triage of incoming test results, patient requests and pharmacy renewals; facilitates… more
- CVS Health (Topeka, KS)
- …Spanish. **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. + … more
- CVS Health (Topeka, KS)
- …service **Preferred Qualifications** - Crisis intervention skills preferred - Managed care/ utilization review experience preferred - Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. * … more
- CommonSpirit Health (Phoenix, AZ)
- …just, equitable, and innovative healthcare delivery system. **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management… more
- Spectrum Health Services (Philadelphia, PA)
- …health and/or psychosocial problems through practice and home-based visits and telephonic support on a care management or case management basis appropriate ... team, assesses patients for risk of adverse health outcomes, inappropriate utilization , and monitors the impact of care management interventions. Essential… more
- ChenMed (Philadelphia, PA)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- CareOregon (Portland, OR)
- …financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, ... forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. This position… more
Related Job Searches:
RN Telephonic Utilization Review,
Review,
Telephonic,
Telephonic Utilization Review Nurse,
Utilization,
Utilization Review