- AmeriHealth Caritas (Newark, DE)
- ** Utilization Management Plan Oversight Manager, Registered Nurse (must reside in DE)** Location: Newark, DE Primary Job Function: Medical Management ... and serves as SME for clinical components DE Medicaid Utilization Management Program. Works in close collaboration... program. + Act as a primary liaison with plan providers including but not limited to physicians, hospital… more
- CenterWell (Dover, DE)
- …payer contracts + Monitor the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care Evaluation + Policies and ... and determining the best course of action. + Delegation Oversight of Home infusion Nursing Vendors and local providers...criteria for admission to service, case assignments, and case management . + Represent the pharmacy in a professional and… more
- AmeriHealth Caritas (Newark, DE)
- …in collaboration with the Corporate Medical Director(s), Senior Medical Directors, Utilization Management and the CMO. The following responsibilities are ... Preferred Provider Organization (PPO), large Health Care Organization, health plan or any combination thereof, or Full-time medical facility...+ 5+ years of clinical practice. + Experience in Utilization Management as a Medical Director within… more
- CenterWell (Dover, DE)
- …optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and serve as a national clinical program leader ... This role reports to the National Director, High Risk Patient Management . Responsibilities will include: + Lead comprehensive clinical pharmacy service development,… more