- CVS Health (Denver, CO)
- … clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Highmark Health (Denver, CO)
- …needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, ... while also being capable of developing technical solutions. The consultant will act as a senior resource within the...the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The… more
- CommonSpirit Health (Englewood, CO)
- …and Responsibilities** **This is a remote position** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred ... and options/alternatives for care. The PA acts as a consultant to, and resource for, attending physicians regarding their...Management Teams: Makes telephonic/electronic contacts with case and utilization management to discuss clinical … more
- CVS Health (Denver, CO)
- …relations; customer service or audit experience. Experience in research and analysis of utilization management systems. *Fluent in Spanish, both oral and written ... accuracy and appropriateness of a benefit/administrative denial. Can review a clinical determination and understand rationale for decision. Able to research claim… more