- US Tech Solutions (RI)
- …support as required. **Responsibilities:** + Reviews documentation and evaluates potential quality of care issues based on clinical policies and benefit ... Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION... review. + MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more
- CVS Health (Providence, RI)
- …we do it all with heart, each and every day. **Position Summary** _Utilization Management is a 24/7 operation and work schedules will include weekends, holidays, and ... other products, services and/or programs. + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization. + Consults and… more
- CVS Health (Providence, RI)
- …do it all with heart, each and every day. **Position Summary** _Utilization management is a 24/7 operation. Work schedules will include weekend/holiday and evening ... other products, services and/or programs + Identifies opportunities to promote quality effectiveness of Healthcare Services and benefit utilization + Consults and… more
- Prime Therapeutics (Providence, RI)
- …education and/or relevant work experience + 5 years of work experience in case management or professional practice + Current Registered Nurse (RN) license in ... passion and drives every decision we make. **Job Posting Title** SIU Clinical Consultant **Job Description** The SIU Clinical Consultant is responsible for… more
- Highmark Health (Providence, RI)
- …of clinical, quality , care, utilization, high-cost claim, and population health management . Must be a recognized subject matter expert (SME). + Clinical Program ... in Business or Clinical field **LICENSES or CERTIFICATIONS** **Required** + Registered Nurse (RN) or Pharmacist (Pharm D) or Physician Assistant (PA) **Preferred** +… more
- University Medicine (Cranston, RI)
- …This position includes the opportunity for research and teaching. SUMMARY: The Nurse Practitioner/Physician Assistant will provide quality primary care services ... of Medicine. The three-part mission of Brown Medicine is high-level quality patient care, state-of-the-art clinical research, and dedicated teaching of more… more
- Genesis Healthcare (RI)
- …between our centers located in Rhode Island. This position can be filled by a nurse practitioner or physician assistant. The hourly range for this position is $58 - ... of skilled nursing and senior living facilities. Our physicians, nurse practitioners (NPs) and physician assistants (PAs) are supported...long-term care. At AlignMed, we believe in a better quality of life for all. Our mission is to… more
- Lincoln Financial (Providence, RI)
- …you will be responsible for leading and managing a team of nurse disability consultants and behavioral health consultants. This includes partnering closely with ... medical and vocational operations and serve as a consultant to the claim operations team for complex clinical...area(s) of responsibility, assesses the impact, and collaborates with management to incorporate new trends and developments in current… more