- Intermountain Health (Las Vegas, NV)
- …interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network management ... finance. As the Medical Director for Utilization Management , you are responsible, in partnership with MG Clinical...order to be considered for the position.** Performs medical review activities pertaining to utilization review… more
- HCA Healthcare (Las Vegas, NV)
- …issues. Offers clinical support for appeals and denials process, discharge planning, case management , and utilization review / management . + Consults with ... a data-driven environment of quality and cost improvement, and develops systems to review utilization of resources and objectively measure outcomes of care in… more
- HCA Healthcare (Henderson, NV)
- …(EHR). Using a balanced combination of advanced customer service, project management , sales, leadership, training, and technology skills, the Consulting Provider ... the healthcare continuum from the introduction to adoption and advancing utilization of HCA ambulatory EHR technologies. Duties also include ensuring providers… more
- HCA Healthcare (Las Vegas, NV)
- …support the Supply Chain team to lead margin improvement activities, which includes inventory management and patient billing review . The VPDCO will review ... in operations, expense, clinical integration, quality, and service + Execute clinical utilization and expense management plans and ensure alignment with facility… more
- Elevance Health (Las Vegas, NV)
- …+ Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + ... preferred. + Extensive orthopedic surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For… more
- ICW Group (Las Vegas, NV)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... ensure quality and appropriate service delivery of the case management process. + Performs initial and ongoing clinical assessment...Providers. + May perform Utilization Review activities (or review … more
- Fresenius Medical Center (Las Vegas, NV)
- …in contracted hospitals/facilities and ensure efficient patient scheduling and staff utilization in accordance with the TAP scheduling tool. + Maintain and ... review the daily TAP tool for all hospitals/facilities under...daily patient care needs and communicate concerns to attending physician . Implement changes in patient care/treatment as directed and… more
- HCA Healthcare (Las Vegas, NV)
- …the patient stay, managing the length of stay, ensuring appropriate resource management , and developing a safe appropriate discharge plan in collaboration with the ... supporting a balance of optimal care and appropriate resource utilization . What you will do in this role: +...do in this role: + You will provide case management services for both inpatient and observation patients as… more
- Sedgwick (Las Vegas, NV)
- …physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. **ADDITIONAL ... college or university preferred. **Experience** Two (2) years of claims management experience or equivalent combination of education and experience or successful… more
- Sedgwick (Las Vegas, NV)
- … physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. + Performs other ... knowledge of regulations, offsets and deductions, disability duration, medical management practices and Social Security and Medicare application procedure as… more