- Moses/Weitzman Health System (Meriden, CT)
- …component meeting client's health care needs. Participates with Community Health Center management in developing and achieving optimal clinical performance and ... licensure as appropriate. Fully established practice standards for productivity and appropriate utilization of care. Position is designed to support evening and or… more
- CVS Health (Hartford, CT)
- … 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
- CVS Health (Hartford, CT)
- …Must have active current and unrestricted RN licensure in state of residence - Utilization Management is a 24/7 operation and work schedules will include ... in med surg or specialty area - Managed Care experience preferred, especially Utilization Management - Preference for those residing in EST/CST zones… more
- Elevance Health (Wallingford, CT)
- ** Utilization Management Medical Director- NC Medicaid** Location: This role enables associates to work virtually full-time, with the exception of required ... Alternate locations may be considered. The **Medical Director** will be responsible for utilization review case management for North Carolina Medicaid. May be… more
- Highmark Health (Hartford, CT)
- …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
- Elevance Health (Wallingford, CT)
- Provider Success Consultant Sr. (Value-Based) (JR172104) **Hybrid 1:** This role requires associates to be in-office **1 - 2** days per week, fostering collaboration ... unless an accommodation is granted as required by law._ The **Care Consultant Sr.** (Provider Success) is responsible for the provider performance of value-based… more
- Nuvance Health (Danbury, CT)
- …of hospitalization, LOC status, LOS management , continued stay decisions, clinical review of patients, utilization review activities, resource utilization ... , quality, and administrative facets of the healthcare industry. * Strong clinical acumen; Knowledge of Care Management / Utilization Review principles,… more
- The Cigna Group (Bloomfield, CT)
- …and external customers. He/she will serve as a clinical educator and consultant to utilization management , case management , network, contracting, ... of position** : A Medical Principal performs medical review and case management activities. The physician provides clinical insight to the organization… more
- Elevance Health (Wallingford, CT)
- …Capabilities and Experiences:** + Child and Adolescent experience preferred. + Utilization Management experience. + Applied Behavior Analysis (ABA) experience. ... discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May...an entire clinical program and/or independently performs clinical reviews. + Typically has program management … more
- Elevance Health (Wallingford, CT)
- …clinical reviews. The Medical Director typically has program management responsibilities including clinical policy development, program ... programs to improve quality, cost, and outcomes. May provide clinical consultation and serve as clinical /strategic advisor...discuss review determinations. + Serves as a resource and consultant for other areas of the company. + May… more
- Hartford HealthCare (Hartford, CT)
- …Diseases provides inpatient and outpatient consultation regarding the diagnosis and management of all types of infectious diseases. The service is supported ... by outstanding clinical diagnostics laboratories, which provide state-of-the-art techniques for rapid diagnosis of infectious diseases. Our staff of providers,… more
- Hartford HealthCare (Hartford, CT)
- …ClinicNurse Navigator provides skilled nursing care to patients in a variety of clinical settings. Scope of responsibility is characterized by use of nursing process ... The goals include reducing all-cause readmissions, and inappropriate ED utilization , improving care coordination for patients during the transitional care… more
