- Humana (Honolulu, HI)
- …Caring, Curious and Committed? If so, apply today! The Utilization Management Behavioral Health Professional 2 + Uses clinical knowledge, communication ... put health first** Humana Healthy Horizons is seeking a Utilization Management Behavioral Health Professional 2 who...clinical experience in private practice or other patient care + Must be passionate about contributing to an… more
- Sharecare, Inc. (Honolulu, HI)
- …goals and objectives of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and ... Provider (PCP), and all other members of the health care team to support appropriate total healthcare management...committed individual who recognizes the impact of the health care delivery system on the clinical and… more
- Centerwell (Honolulu, HI)
- …+ Manage a comprehensive clinical portfolio related to acute and post-acute care utilization to improve trend with active cross collaboration with the ... Strategy will be responsible for managing the portfolio of clinical programs to improve medical trend utilization ...a focus on programs that impact acute and post-acute care . The Associate VP, Care Management… more
- Evolent Health (Honolulu, HI)
- …a Cardiology, 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
- CVS Health (Honolulu, HI)
- …part of the account team. As a Clinical Advisor, you will utilize clinical and analytical skills in a managed care environment to positively impact the ... subject matter expert on the account team - Providing clinical consulting services through analyzing drug utilization ...learn multiple internal reporting and analytic tools for client management . - AMCP Fundamentals of Managed Care … more
- Fresenius Medical Center (Honolulu, HI)
- …Travel and able to stay for extended assignment. **About this role:** As a Clinical Manager with Fresenius Medical Care , you will ensure that quality patient ... care is delivered while maintaining clinical operations. As the facility leader, you will be...Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and… more
- Takeda Pharmaceuticals (Honolulu, HI)
- …be empowered to take charge of your future at Takeda. Join us as a Clinical Sales Specialist in our Virginia Beach, VA territory. Here, everyone matters, and you ... will be an important contributor to our inspiring, bold mission. As a Clinical Sales Specialist working on the Gastroenterology Specialty Sales Team, you will be… more
- Wolters Kluwer (Honolulu, HI)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + Ongoing Utilization Management + Oversee customer utilization and product ... lead role in managing and driving our customer's product utilization across the Clinical Effectiveness (CE) product...technology (HIT) provider working on the front lines of clinical care . Our talented team of physician… more
- Humana (Honolulu, HI)
- …Director) is dedicated full time to the Indiana Pathways program to assist the Utilization Management , Care Management , and Quality departments' staff ... of decisions to internal associates, and possible participation in care management . The clinical scenarios...care experience working with LTSS program population. + Utilization management experience in a medical … more
- Highmark Health (Honolulu, HI)
- …Formularies, utilization management programs, and case/ disease management initiatives; providing clinical review and decisions for physician and ... Organization's Formularies, utilization management programs, and disease management initiatives. + Provide clinical review and decisions including but… more
- Sedgwick (Honolulu, HI)
- Taking care of people is at the heart of...RESPONSIBILITIES** + Accesses and assigns cases for medical case management , utilization review and clinical ... information to callers based on customer requests; triages telephone calls between utilization review, clinical consultation and telephonic case managers. +… more
- Always Best Care Senior Services (Honolulu, HI)
- …assists with the planning, coordination, leading, controlling, and evaluation of home care services. The NS is responsible for coordination and liaison with ... NS directs and supervises professional and paraprofessional personnel rendering client care services, performs marketing duties, and fosters public relations for the… more
- Always Best Care Senior Services (Honolulu, HI)
- …assists with the planning, coordination, leading, controlling, and evaluation of home care services. The NS is responsible for coordination and liaison with ... NS directs and supervises professional and paraprofessional personnel rendering client care services, performs marketing duties, and fosters public relations for the… more
- Always Best Care Senior Services (Honolulu, HI)
- …managing teams with at least 2-3 years in a leadership role, plus have an outstanding desire to provide great customer service and creative clinical management . ... a fast growing, results oriented Home Health and Home care business. As the fastest growing home care...Additional responsibilities: * Develops a process to monitor appropriate utilization of services. * Directs the implementation of service… more
- Wolters Kluwer (Honolulu, HI)
- …nurses, and pharmacists every day as they work on the front lines of clinical care . Our talented team of physician editors, technologists, and product ... including: Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations; Overseeing contract… more
- Elevance Health (Kapolei, HI)
- …member and the health care team, to ensure cost effective and efficient utilization of health benefits. + Decision making skills will be based upon the current ... check, or ask you for payment as part of consideration for employment. **Managed Care Coordinator Clinician Non RN** + Job Family: MED > Licensed/Certified - Other +… more
- Wolters Kluwer (Honolulu, HI)
- …innovation-driven healthcare information technology (HIT) provider working on the forefront of clinical care . Our accomplished team of physician and pharmacist ... measurably improve clinical effectiveness by helping healthcare professionals provide optimal care for their patients. CE's mission is to improve care … more
- Humana (Honolulu, HI)
- …daily work, communication of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from ... insurance, other healthcare providers, clinical group practice management . + Utilization management experience...region or line of business. The Medical Director conducts Utilization Management of the care … more
- Humana (Honolulu, HI)
- …daily work, communication of decisions to internal associates, and possible participation in care management . The clinical scenarios predominantly arise from ... insurance, other healthcare providers, clinical group practice management . + Utilization management experience...region or line of business. The Medical Director conducts Utilization Management of the care … more
- Marriott (Honolulu, HI)
- …claims most likely to benefit from case management to meet jurisdictional needs. Utilization Review + Provide initial clinical review in order to certify ... States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** The Nurse CARE Manager coordinates timely,… more