- Humana (Richmond, VA)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who ... and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Process Improvement Professional 2 analyzes, and measures the effectiveness of existing ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Understands department,… more
- CenterWell (Richmond, VA)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Humana (Richmond, VA)
- …put health first** This is a non-exempt position with responsibility for utilization management and clinical decision-making as outlined in the Autism Care ... Responsibilities** Tasks include, but are not limited to: **70%** : Performing utilization management activities for assigned areas. Ensures full compliance with… more
- Evolent Health (Richmond, VA)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Richmond, VA)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Richmond, VA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- ChenMed (Richmond, VA)
- …required. + A minimum of 1 year of utilization review and/or case management , home health , hospital discharge planning experience required. + A minimum ... other case managers and nurses, acute and post-acute facilities, home health care companies, and health...and post-acute setting. Coordinates the patient care, discharge and home planning processes with hospital case management … more
- CVS Health (Richmond, VA)
- …as optimization of medication selection, dosing, and monitoring + Experience with population health and/or disease state management + Ability to research and ... Bring your heart to CVS Health . Every one of us at CVS ...affordable. Position Summary: The Clinical Pharmacist performs retrospective drug utilization reviews. They distribute clinical drug information and educate… more
- Sharecare, Inc. (Richmond, VA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Humana (Richmond, VA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid… more
- Elevance Health (Richmond, VA)
- …role required by a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. + Ability to meet necessary ... **Medical Director** At **Federal Health Products and Services - FHPS** , a...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more
- ChenMed (Richmond, VA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in this role ... management functions into the patient care, discharge and home planning processes with other departments, external service organizations, agencies and… more
- Elevance Health (Richmond, VA)
- …in nursing and a minimum of 3 years of condition-specific clinical or home health /discharge planning experience; or any combination of education and experience, ... Management II** **$2000 Sign on Bonus** At **Federal Health Products and Services - FHPS** , a proud...for multiple managed conditions to ensure cost-effective and efficient utilization of health services. Conducts assessment, planning,… more
- HCA Healthcare (Hopewell, VA)
- …transition to the appropriate next level of care.7. Has working knowledge of utilization management and case management functions and performs these ... **Description** Introduction Do you have the career opportunities as a Behavioral Health Counselor you want with your current employer? We have an exciting… more
- Bon Secours Mercy Health (Richmond, VA)
- …**Minimum Qualifications** Minimum Years and Type of Experience 2-3 years acute care, home health or case management experience Other Knowledge, Skills ... At Bon Secours Mercy Health , we are dedicated to continually improving ...Nurse, the Ambulatory Care Manager will provide clinical care management services to identified eligible patients; coordinating care to… more
- Bon Secours Mercy Health (Richmond, VA)
- …LCSW **Minimum Qualifications** Minimum Years and Type of Experience 2-3 years acute care, home health or case management experience Other Knowledge, Skills ... At Bon Secours Mercy Health , we are dedicated to continually improving ...the capacity of a Social Worker, provide clinical care management services to identified eligible patients, coordinating care to… more
- Bon Secours Mercy Health (Richmond, VA)
- …and understanding they must float to assigned sites within the Bon Secours Mercy Health System outside of their home market (no local placements). **Our System ... float to assigned sites within the Bon Secours Mercy Health System outside of their home market...* Inter-professional collaboration and leadership + * Understanding and utilization of office and clinical technologies + * Compassionate,… more
- Molina Healthcare (Glen Allen, VA)
- …performing one or more of the following activities: care review/ utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.), ... case management , transition of care, health management and/or member assessment. + Typically,...years in one or more of the following areas: utilization management , case management , care… more