- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for ... Utilization Management and Review for...Utilization Management and Review for the Enterprise. The...team in delivering and collaborating on all aspects of utilization management and care coordination… more
- Zurich NA (Carson City, NV)
- …+ Experience in development and implementation of cost containment programs + Case management , utilization review , catastrophic or disability experience + 5 ... AVP, Utilization Review & Pharmacy 123092 Zurich...Care and Claims leadership to create and align utilization and pharmacy cost containment strategies with our customers'… more
- Intermountain Health (Las Vegas, NV)
- …position interacts with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management , care management , claims, network ... management , and finance. As the Medical Director for Utilization Management , you are responsible, in partnership...order to be considered for the position.** Performs medical review activities pertaining to utilization review… more
- Centene Corporation (Carson City, NV)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization...healthcare teams to review care services related to mental health… more
- Reno Behavioral Healthcare Hospital (Reno, NV)
- …as appropriate. + Coordinates an interdisciplinary approach to support continuity of care . + Provides utilization management , transfer coordnation, discharge ... The UR Specialist reviews and monitors patients' utilization of health care services with...reviews on all patients. Monitors level and quality of care . + Responsible for the proactive management … more
- Sedgwick (Las Vegas, NV)
- …Work(R) Fortune Best Workplaces in Financial Services & Insurance Physical Therapy Utilization Review Advisor **For client coverage; prefer someone in Mountain ... updated with relevant industry regulations, guidelines, and best practices related to utilization review and maintains compliance with applicable laws and… more
- CenterWell (Carson City, NV)
- …program workflows, dyad communication/partnership, and quarterly business review of acute care and post-acute care utilization . + Engage with divisional ... coordinating care to reduce acute and post-acute care utilization . The Divisional Director role is...work with EMR, operational and outcome reporting, knowledge of care management tools and assessments, documentation, and… more
- Humana (Carson City, NV)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...region or line of business. The Medical Director conducts Utilization Management of the care … more
- Highmark Health (Carson City, NV)
- …This job implements effective ** utilization management ** strategies including: review of appropriateness of health care services, application of criteria ... inquiries and offers interventions and/or alternatives. **ESSENTIAL RESPONSIBILITIES** + Implement care management review processes that are consistent… more
- Highmark Health (Carson City, NV)
- …needs and/or triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with ... **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management ...care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Evolent (Carson City, NV)
- …meaningful impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director, Cardiovascular Specialist and ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Dignity Health (Henderson, NV)
- …+ Oversees the department in an efficient manner to ensure timely and compliant care coordination, discharge planning, utilization review and social work ... other managers, physicians, administration, and community based healthcare workers regarding care management issues identified through corporate or facility… 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 ... of quality and cost improvement, and develops systems to review utilization of resources and objectively measure...delegated utilization management and disease management operations under managed care contracts. Meets… more
- Evolent (Carson City, NV)
- …the support services review process. Responsible for the quality of utilization review determinations, including appeals. + Provides input into audit ... and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented...needed for new hires to educate and train on Utilization management system and Field Medical Director… more
- Evolent (Carson City, NV)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Evolent (Carson City, NV)
- …specialty match reviewer for Spine Surgery cases. you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… 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 ... to caring for patients with purpose and integrity. We care like family! Jump-start your career as a(an) Vice...expense, clinical integration, quality, and service + Execute clinical utilization and expense management plans and ensure… more
- Humana (Carson City, NV)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, ...region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Carson City, NV)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...- North Central Medicaid Markets. The Medical Director conducts Utilization Management of the care … more
- Evolent (Carson City, NV)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more