- 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)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Prime Therapeutics (Indianapolis, IN)
- …MRx - Oncology - 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)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... Director for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical… 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
- 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
- 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
- Elevance Health (Indianapolis, IN)
- …and Experiences:** + Home health experience preferred. + 1 year of Utilization Management experience preferred. + Multi-State/Compact Nursing License strongly ... reviews telephonically using the members medical records discussion with the members physician and/or discussion with Home health agency staff. + Contacts the home… more
- Elevance Health (Indianapolis, IN)
- …preferred. + Extensive 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
- 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
- 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
- Elevance Health (Indianapolis, IN)
- …Develops and enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease Management , ... Administrative Medicine, Business Strategy, Product Strategy. + Experience with Managed Care, Utilization Management , Prior Auth, and Benefits Management … 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 ... the Elevance Health family of companies, Carelon Medical Benefits Management , is a benefit- management leader in Illinois....insurance, government programs etc. + 5-10 years leading physician teams in either payor or managed care organizations.… more
- Community Health Network (Indianapolis, IN)
- …Oncology Department Oncology Product Line Schedule Full-time Facility Community Physician Network Indianapolis Northside 1 Indianapolis, IN 46256 United States ... (Required) * Provider Relations: Works in coordination with Product Line and Physician Leadership to ensure Provider staffing meets the budgeted volumes. Works as… more
- Elevance Health (Southport, IN)
- …**RN Case Manager** **(LTSS Service Coordinator- RN)** is responsible for overall management of member's case within the scope of licensure; provides supervision and ... face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Elevance Health (Indianapolis, IN)
- **Clinical Operations Associate Medical Director** **Carelon Insights** **Post Acute Care Utilization Review** _Schedule: 11-8 Central Time_ A proud member of the ... Associate Medical Director** is responsible for supporting the medical management staff ensuring timely and consistent medical decisions to...of clinical case reviews for post-acute care. + Makes physician to physician calls to gather medical… more
- Community Health Network (Indianapolis, IN)
- …of care for the patient. - Establishes the discharge plan with the patient, physician , and care management team for identified patients. - Implements the ... PRN Job Ref 2403429 Category Nursing Job Family Case Manager Department Case Management Schedule Per Diem Facility Community Hospital South 1402 E County Line Rd… more