- Elevance Health (Indianapolis, IN)
- **Clinical Operations Associate Medical Director** **Carelon Health** **Genetics Testing Utilization Review ** **Location** : The ideal candidate will live within ... necessity decisions. + Brings to their supervisors attention, any case review decisions that require Medical Director...Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance… more
- Community Health Network (Indianapolis, IN)
- …continuity of care and cost effectiveness through the integrating and functions of case management, utilization review and management and discharge planning. ... Registered Nurse (RN) Case Manager - Community South Job...of care to ensure quality patient outcomes and appropriate utilization of health care services. Responsible for supporting the… more
- International Medical Group (Indianapolis, IN)
- …visa status (eg, H-1B or TN status) for this position. JOB SUMMARY The Case Manager will evaluate medical necessity, appropriateness, and efficiency of the use ... of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured, the insurance… more
- Kepro (Bloomington, IN)
- …partner for health solutions in the public sector. Acentra seeks an RN Complex Case Manager in Logan, Ohio (covering Athens, Meigs, Gailia, Vinton, Jackson and ... join our growing team. Job Summary: The RN Complex Case Manager will: + Provide in-home, in-person...Ensure day-to-day processes are conducted in accordance with the Utilization Review Accreditation Commission (URAC) and other… more
- Elevance Health (Indianapolis, IN)
- **Telephonic Nurse Case Manager II** **Location: This is a virtual position. Candidates must reside within 50 miles of an Elevance Health Pulse Point location.** ... in different states; therefore, Multi-State Licensure will be required.** The **Telephonic Nurse Case Manager II** is responsible for care management within the… more
- CenterWell (Avon, IN)
- …action through the utilization of Performance Improvement principles. + Responsible for review of the appropriate number of Case Managers and clinical staff ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and… more
- Highmark Health (Indianapolis, IN)
- …Inc. **Job Description :** **JOB SUMMARY** This job implements the effective utilization management strategies including: review of appropriateness of health ... care services, application of criteria to assure appropriate resource utilization , identification of opportunities for referral to a Health Coach/ case … more
- Confluent (Indianapolis, IN)
- …targeting and program performance measurement. + Build, evangelize, and drive utilization of campaign briefs as well as detailed, integrated campaign playbooks, ... proposition, pre/during/post promotional strategies/tactics, long form assets (white papers, case studies, webinars), short form/promotional assets (blogs), down funnel… more
- Prime Therapeutics (Indianapolis, IN)
- …clinical experience. + Experience in managed care, specialty drugs, care management and utilization review . + Meets Magellan Credentialing criteria. + At minimum ... for drug services. + Will actively maintain a required case load and the activities to reach overall goals...Quality oversight for this program is provided by the Manager , Patient Programs. **Responsibilities** + Registered Nurse (RN). +… more
- Lumen (Indianapolis, IN)
- …be responsible for evaluating and planning optimal network solutions utilization Lumen standards, consumption trends, new technologies, industry design requirements ... installations of network standards. + Knowledge of Project Reporting - effectively review and communication of project plans and status with high clarity,… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... ensuring clinical integrity of broad and significant clinical programs. May perform clinical review . **How you will make an impact:** + May provide clinical guidance… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... clinical operational aspects of a program. + May conduct peer-to-peer clinical appeal case reviews with attending physicians or other ordering providers to discuss … more
- SitusAMC (Indianapolis, IN)
- …offerings within SitusAMC. This role will work with other Client Service Manager ("CSM") team members across the organization to support efficient usage of ... to make decisions and remove impediments to increase client satisfaction and utilization + Liaise and communicate progress between sr. management and other internal… more