- CVS Health (Richmond, VA)
- …internal and external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications : - Must have ... solutions to make health care more personal, convenient and affordable. Utilizes clinical experience and skills in a collaborative process to plan, implement,… more
- CVS Health (Richmond, VA)
- …to make health care more personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote ... live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in...external constituents in the coordination and administration of the utilization /benefit management function. Required Qualifications - 3+… more
- CVS Health (Richmond, VA)
- …work occasional holiday and weekends depending on business needs Preferred Qualifications - Utilization management experience - Managed care experience - Must be ... services. Maintains accurate and complete documentation to meet risk management , regulatory, and accreditation requirements. Promotes communication, both internally… more
- CVS Health (Richmond, VA)
- …convenient and affordable. Position Summary Applies critical thinking, evidenced based clinical criteria and clinical practice guidelines for services requiring ... a desk and on the phone collecting and reviewing clinical information from providers. Precertification nurses use specific criteria...or multi state compact licensure + 3+ years of clinical experience + Must be willing and able to… more
- Abbott (Richmond, VA)
- …support diagnostic testing which provides important information for treatment and management of diseases and other conditions. **The Opportunity** We currently have ... an opportunity for a Technical Consultant . This is a remote, field-based position located in...accounts. This position will also provide education of the clinical utility of our products in the laboratory and/or… more
- Lincoln Financial Group (Richmond, VA)
- …a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for ... industry experience preferred * Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or… more
- Highmark Health (Richmond, VA)
- …and Sales leadership to present and prepare data analyses, pharmacy management strategies and pharmacy capabilities to Organization clients and potential clients. ... and quotes. Runs financial reports or performs basic financial analysis on utilization data and market research and analysis. Develop detailed specifications for… more
- CVS Health (Richmond, VA)
- …Liaison is a clinical leader in the Medicaid plan focusing on utilization management , integrating member care, clinical coordination, leading the ... mental health services and addiction recovery and treatment services through the utilization management process + Drives collaboration on quality of care,… more
- Kepro (Richmond, VA)
- … Reviewer (part-time) to join our growing team. Job Summary: Our Behavioral Health Utilization Management Clinical Reviewer will use clinical expertise ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- CVS Health (Richmond, VA)
- …mental health services and addiction recovery and treatment services through the utilization management process - Drives collaboration on quality of care, ... utilization management , disparities and care coordination to...and confident making decisions, ability to influence and shape clinical outcomes, a strong clinical consultant… more
- Elevance Health (Virginia Beach, VA)
- …assigned state with over 2M members. In this dynamic position you will provide clinical expertise leadership and oversight of care management to drive strategic ... to NY, IN, VA, and GA. **Summary:** The RVP Clinical Officer for the East Region will provide strategic...cost and outcomes. + Directs and manages the Medical Management staff to ensure timely and consistent responses to… more
- Bon Secours Mercy Health (Richmond, VA)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. Job Description **Primary Function/General Purpose of ... at a Masters level in nursing with expertise in a specific area of clinical nursing practice. By definition, "Advanced practice nursing is the application of an… 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 ... discuss review determinations. + Serves as a resource and consultant to other areas of the company. + May... reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program… more
- Veterans Affairs, Veterans Health Administration (Richmond, VA)
- …Therapy (PT) Section Supervisor is responsible for the supervision, administrative management , and direction of the Outpatient physical therapy programs at the ... a High Complexity Level 1 facility. The incumbent provides supervision of key clinical and training programs, including the overall technical oversight of the 20+ PT… more
- Elevance Health (Norfolk, VA)
- … reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, ... 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 to other areas of the company. + May… more
- Elevance Health (Richmond, VA)
- … reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, ... 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 to other areas of the company. + May… more
- Wolters Kluwer (Richmond, VA)
- …Consulting Manager - Pharmacy Compliance ensures successful adoption and optimal utilization of our Simplifi+ and Sentri7 pharmacy portfolios by acting as ... the subject matter expert and consultant . **Duties and responsibilities** In the role, the Specialized...contributes to the success of our customers and the Clinical Surveillance and Compliance (CSC) business unit at Wolters… more