- US Tech Solutions (Canton, MA)
- …of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... remote, but Massachusetts RN license required. Job Summary The Clinical Reviewer is a licensed professional -a...nd unrestricted Massachusetts license required Minimum of five years clinical experience in utilization management ,… more
- Lifespan (Providence, RI)
- …and implements corrective strategies to optimize drug use in compliance with clinical usage guidelines. Participates in quality management and quality ... Manager as applicable. Under the supervision of the Pharmacist-In-Charge, Senior Clinical Pharmacist Specialist, or Clinical Coordinator as appropriate… more
- UMass Memorial Health (Worcester, MA)
- …senior management on various financial indicators, including productivity, supply utilization , and volume. Obtains data from the financial systems as needed. ... and managing the administrative/business affairs which may include billing, clinical , service and educational activities. Collaborates with appropriate leadership… more
- OptiMindHealth (Needham, MA)
- …improve access to holistic and cost-effective mental health care while supporting our clinical and administrative staff in all aspects of their work. Our team ... all aspects of referral relationships including access, communication and medical management are working positively for these medical providers and healthcare… more
- US Tech Solutions (Canton, MA)
- …of clinical decision making and support needed to perform utilization management , medical necessity determinations and benefit determinations using ... remote, but Massachusetts RN license required.** **Job Summary The Clinical Reviewer is a licensed professional -a...unrestricted Massachusetts license required + Minimum of five years clinical experience in utilization management ,… more
- Evolent (Providence, RI)
- …from providers per guidelines. + Utilizing clinical guidelines approved by the Utilization Management Committee (UMC), the URN has the authority to authorize ... cost-effective care. **Collaboration Opportunities** : As a Radiation Technologist in the Utilization Management department, you will work closely with other… more
- Evolent (Providence, RI)
- …the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready ... make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management...within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure… more
- Evolent (Providence, RI)
- …clinical expertise in developing cardiovascular programs that include improvements to clinical effectiveness of utilization management (UM) and risk-based ... critical role in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a… more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Providence, RI)
- …Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical ...with prior experience participating in teams focusing on quality management , utilization management , case … more
- Humana (Providence, RI)
- …role, you will be a key enterprise leader, with responsibility for evolving Humana's Utilization Management of medical review by physician or nurse, with ... + Lead an operational team of Medical Directors to review authorizations and ensure clinical decision-making skills...efforts to improve the efficiency of health plan operations ( utilization management and provider clinical … more
- Evolent (Providence, RI)
- …match reviewer for Spine Surgery cases. you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Fresenius Medical Center (Lincoln, RI)
- …or federal surveys. + Participates in the completion of the FMS Administrative Clinical Review . **PHYSICAL DEMANDS AND WORKING CONDITIONS:** + The physical ... requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all legal, compliance, and regulatory… more
- Evolent (Providence, RI)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... when available, within the regulatory timeframe of the request. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the… more
- Prime Therapeutics (Providence, RI)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship. **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR… more
- Charter Care Health Partners (North Providence, RI)
- …progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management ; Continuum of Care ... Management (Discharge planning) and Clinical Documentation Management . Collects data via utilization with Care...experience with case management , patient navigation, case management , utilization review or discharge… more
- Prime Therapeutics (Providence, RI)
- …and drives every decision we make. **Job Posting Title** Sr Director Clinical Strategy and Oncology Specialty Solutions- REMOTE **Job Description** The Senior ... Director Clinical Strategy and Oncology Specialty Solutions is responsible for...implementation of innovative drug solutions, including optimizing optimize drug utilization , patient outcomes, and cost-effectiveness through value-based care models,… more
- Evolent (Providence, RI)
- …As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent (Providence, RI)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... provides clinical rationale for standard and expedited appeals. . Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
