- Novo Nordisk Inc. (Philadelphia, PA)
- …productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights ... Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level business acumen and… more
- 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
- Sutter Health (Sacramento, CA)
- …Advisor will work closely with the medical staff, including house staff, and all utilization management (UM) personnel, Care Management (CM) personnel to ... services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of...within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation… more
- CommonSpirit Health (Houston, TX)
- …a remote position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
- Covenant Health Inc. (Knoxville, TN)
- …Operations Coordinator will perform activities to help facilitate utilization management functions related to the coordination of physician advisor related ... denials. + Maintains a monthly data report on each physician 's activities impacting Utilization Management ...correctly managed. + Keeps abreast of current changes affecting Utilization Review as applicable. + Adjusts patient… more
- UPMC (Pittsburgh, PA)
- The Medical Director, Utilization Management is responsible for assuring physician commitment and delivery of comprehensive high-quality health care to UPMC ... Life Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes,… more
- Veterans Affairs, Veterans Health Administration (Loma Linda, CA)
- …Experience supervising physicians and supporting utilization management as a Physician Utilization Management Advisor (PUMA) is preferred; Must be ... L. Pettis Memorial Veterans Hospital is recruiting for a Full-Time, Permanent, Physician , Chief of Inpatient Medicine and reports directly to the ED-Inpatient… more
- UNC Health Care (Chapel Hill, NC)
- …high-quality, and cost-effective care. Collaborates closely with Case Management , Utilization Management , and SES/Executive Physician leadership to ... in clinical and operational performance. Key responsibilities include supporting the Utilization Management program, leading efforts in denial management… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …Mental Health services on various Medical Center committees; serving as the back-up Physician Utilization Management Advisor (PUMA) for Mental Health; ... West Palm Beach VA Medical Center is seeking a Physician (Psychiatry) to serve as an Intensive Community Mental...Service, will oversee many aspects of mental health resource utilization , such as use of psychotropic medications and mental… more
- Veterans Affairs, Veterans Health Administration (West Palm Beach, FL)
- …(HRO), performs psychiatry Quality of Care audits and functions as the Department Physician Utilization Management Advisor (PUMA) to ensure compliance. ... of mental health. Incumbent collaborates and participates with facility leadership and Utilization Management to ensure practices follow JC, CARF, and CO… more
- ChenMed (Miami, FL)
- … Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other duties ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- Nuvance Health (Danbury, CT)
- …rotate one weekend per month Summary: The purpose of the Utilization Management Nurse is to support the physician , the interdisciplinary team, and ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …expert for member and provider submitted appeals. Working collaboratively with Physician review unit, Utilization Management , Case Management , Member ... regulatory timeframes.The TeamAs an integral part of the Appeal Review team, the Clinical Appeals Nurse Reviewer ...and accreditation standards and timeframes. + Collaborate with the Physician Review Units to assist with medical… more
- Elevance Health (Los Angeles, CA)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... **Nurse Reviewer I** **Location:** Virtual: This role enables associates...Skills, Capabilities, and Experiences** ** :** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding,… more
- Elevance Health (San Juan, PR)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... United States and current Puerto Rico Nursing Board license. + Familiarity with Utilization Management Guidelines, ICD-10 and CPT-4 coding, and managed health… more
- Hartford HealthCare (Hartford, CT)
- …Island. We consist of a team of professionals ranging from Medical Assistants to Physician Assistants and everything in between. Our physician led medical group ... The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation,… more
- Elevance Health (Nashville, TN)
- …determining whether clinical information presented meets medical necessity criteria or requires physician review or override. + Clearly and concisely documenting ... **Genetic Counselor Reviewer ** The Genetic Counselor Reviewer (GCR)...in Florida, Georgia, Indiana, and/or Kentucky. + Experience in utilization management and/or reimbursement coding for genetic… more
- Ascension Health (Hoffman Estates, IL)
- …years of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. This position reports ... **Position Highlights** Ascension St. Alexius is looking for a Physician Advisor to join our team. We are looking...of stay determination. + Assist and manage the denial management process. + Review and offer suggestions… more
- Ascension Health (Jacksonville, FL)
- …5 years of recent work experience in a hospital setting, preferably with some Physician Advisory/ Utilization Management work experience. If you are ready ... **Position Highlights** Ascension St. Vincent is looking for a Physician Advisor to join our team. We are looking...of stay determination. + Assist and manage the denial management process. + Review and offer suggestions… more
