- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... Summary: Our Utilization Management Appeals Nurse - LPN/RN will...based on clinical review, criteria, and organizational policies to physician reviewers for final determination. + Resolves complex and… more
- Elevance Health (Indianapolis, IN)
- …+ New Jersey, Morristown **Description** **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits ... Medical Director - Utilization Review** + Job Family: MED > Licensed Physician /Doctor/Dentist + Type: Full time + Date Posted:Apr 17, 2024 + Anticipated End… more
- Prime Therapeutics (Indianapolis, IN)
- … Clinical Reviewer- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
- Evolent Health (Indianapolis, IN)
- …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
- Humana (Indianapolis, IN)
- …Director) is dedicated full time to the Indiana Pathways program to assist the Utilization Management , Care Management , and Quality departments' staff to ... and interpretation skills with prior experience leading teams focusing on quality management , utilization management , discharge planning and/or home health… more
- Highmark Health (Indianapolis, IN)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... Therapeutics Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior… more
- Wolters Kluwer (Indianapolis, IN)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + Ongoing Utilization Management + Oversee customer utilization and product ... You will play a lead role in managing and driving our customer's product utilization across the Clinical Effectiveness (CE) product portfolio. You will act as the… more
- Sedgwick (Indianapolis, IN)
- …FUNCTIONS and RESPONSIBILITIES** + Accesses and assigns cases for medical case management , utilization review and clinical consultation. + Provides accurate ... + Supports clinical staff through the completion of components of the case management and utilization review process. + Schedules diagnostic tests and … more
- Marriott (Indianapolis, IN)
- …Field Case Managers. Claims Services + Collaborate with Claims department regarding case management . + Collaborate with UNM on utilization review issues. + Refer ... care are always adhered to. + Maintain and update physician networks and panels. + Collaborate with treating providers,...load of claims most likely to benefit from case management to meet jurisdictional needs. Utilization Review… more
- Fresenius Medical Center (Carmel, IN)
- …AND SCOPE:** Promotes quality patient care, ongoing customer support and case management for Fresenius Medical Care (FMCNA) renal patient population (internal and ... hospital are required. The position also coordinates activities with physicians, physician offices, dialysis facilities, and pharmacies to ensure that patients'… more
- Wolters Kluwer (Indianapolis, IN)
- …including: Conducting regular account review meetings and reviewing account utilization management reporting to provide recommendations; Overseeing contract ... Kluwer Health entity - is seeking an experienced **Account & Relationship Management Executive** to continue driving growth in their healthcare provider marketplace… more
- Humana (Indianapolis, IN)
- … management of physical and behavioral health services, including utilization management (UM), quality improvement, and value-based payment programs. ... with primary medical providers (PMPs) and specialty providers. + Direct the Quality Management and Utilization Management programs, including, but not… more
- Wolters Kluwer (Indianapolis, IN)
- …working on the forefront of clinical care. Our accomplished team of physician and pharmacist editors, technologists, and product visionaries collaborate to provide ... key contributor within a multifunctional team to drive success and meaningful utilization of the Clinical Effectiveness (CE) product suite. They are responsible for… more
- Elevance Health (Indianapolis, IN)
- …strongly preferred. + Spine surgery experience preferred. + Experience with utilization management , especially with CMS guidelines preferred. For candidates ... Determines the medical necessity of requests using clinical criteria. + Performs physician -level case review of musculoskeletal utilization requests. + Conducts… more
- Intrepid USA (Avon, IN)
- …rules and physician orders + Responsible for efficient and effective utilization management in accordance with client needs, physician orders ... and training to caregiver staff and assures compliance with documentation and physician order requirements. The DOPS must be accountable for adherence to company… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Elevance Health (Indianapolis, IN)
- …Develops and enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease Management , ... Director - Surgery** + Job Family: MED > Licensed Physician /Doctor/Dentist + Type: Full time + Date Posted:Apr 17,...Business Strategy, Product Strategy. + Experience with Managed Care, Utilization Management , Prior Auth, and Benefits … more
- Elevance Health (Indianapolis, IN)
- …care system including but not limited to health care economics, health care delivery, utilization management , case management , utilization review, health ... MBM - Carelon** + Job Family: MED > Licensed Physician /Doctor/Dentist + Type: Full time + Date Posted:Apr 04,...the Elevance Health family of companies, Carelon Medical Benefits Management , is a benefit- management leader in Illinois.… more
- Centerwell (Avon, IN)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more