• Novo Nordisk Inc. (Boston, MA)
    …adverse cardiovascular events. Our ambition is to advance broad cardiometabolic disease management by bringing exciting new therapies to market to improve patient ... productively and respectably challenge and influence target physicians' approach to patient management and adds value by sharing new information and unique insights… more
    HireLifeScience (03/28/24)
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  • Taiho Oncology (Detroit, MI)
    …Sales with access issues and education. Monitor, assess and engage formulary, coverage, utilization review and benefit design policies impacting access to Taiho ... Integrated Delivery Networks (IDNs). Ensure appropriate placement of products in payer, physician network / large group, and Disease Management Companies'… more
    HireLifeScience (03/13/24)
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  • Utilization Management

    Intermountain Health (Las Vegas, NV)
    …position interacts with UM physician and operational leadership. As the UM Physician Reviewer , you are responsible, in partnership with the Sr. Director of ... Leadership. Job Profile: + Trains and educates on medical review activities pertaining to utilization review...criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case… more
    Intermountain Health (03/12/24)
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  • Physician Advisor II

    CommonSpirit Health (Houston, TX)
    …Candidates licensed in other states will be considered for future openings.** As the Utilization Management Physician Advisor II, the Physician Advisor ... staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the...Steering Committee + Extended Length of Stay Rounds + Utilization Review Committee + Care Management more
    CommonSpirit Health (02/03/24)
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  • Physician

    Highland Hospital (Rochester, NY)
    Physician **Department/Cost Center:** 776 - Quality Assurance **Job Description:** The Utilization Management Physician Advisor is responsible for ... serving the hospital through teaching, consulting, and advising the utilization management department. The Physician ...RN will refer cases to the UM PA for review of inpatient, observation or alternative level of care… more
    Highland Hospital (01/27/24)
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  • Physician Advisor

    CommonSpirit Health (Phoenix, AZ)
    …and out in the community. **Responsibilities** This is a remote position. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
    CommonSpirit Health (03/16/24)
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  • Physician Advisor

    CommonSpirit Health (Rancho Cordova, CA)
    …of four 10-hour shifts per week, or five 8-hour shifts per week.** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case ... of health care services. The PA communicates remotely with case and utilization management to discuss selected cases and make recommendations regarding level… more
    CommonSpirit Health (02/22/24)
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  • Physician Advisor

    AdventHealth (Altamonte Springs, FL)
    …managed care payers. The PA role is responsible for providing physician review of utilization , claims management , and quality assurance related to ... **Shift** : **Days** **The role you'll contribute:** As the physician advisor (PA), this role educates, informs, and advises...this role educates, informs, and advises members of the Utilization Management , Health Information Management more
    AdventHealth (03/08/24)
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  • Physician Advisor of Utilization

    Beth Israel Lahey Health (Burlington, MA)
    …resource allocation - Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial ... necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested… more
    Beth Israel Lahey Health (01/07/24)
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  • Utilization Mgmt Reviewer - System…

    Guthrie (Sayre, PA)
    Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
    Guthrie (03/12/24)
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  • Utilization Management Clinical…

    LA Care Health Plan (Los Angeles, CA)
    Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer...submit to the department's Quality Assurance Team and UM Management . Duties Facilitates the development, review , and… more
    LA Care Health Plan (01/14/24)
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  • LPN- Clinical Utilization Reviewer

    Blue Cross Blue Shield of Massachusetts (Quincy, MA)
    …help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer -LPN is responsible for facilitating care for members who ... the LPN UM works collaboratively with the entire Clinical Utilization management team to facilitate care using...potential denial of services is identified. + Refer to Physician Review Unit (PRU) for potential denial… more
    Blue Cross Blue Shield of Massachusetts (02/17/24)
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  • Physician Clinical Reviewer - GI-…

    Prime Therapeutics (Washington, DC)
    …- GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
    Prime Therapeutics (01/03/24)
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  • Psychiatrist Physician Reviewer

    Kepro (Lombard, IL)
    …healthcare challenges. Our culture is fueled by passion and driven by purpose. Psychiatrist Physician Reviewer - PRN - Remote (Within Illinois) + Are you an ... experienced Psychiatrist Physician Reviewer looking for a new challenge?...and clinical expertise to operations relating to the peer review process, utilization review activities,… more
    Kepro (02/19/24)
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  • Cardiology Physician Clinical…

    Evolent Health (Washington, DC)
    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 ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. As well as,... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
    Evolent Health (01/31/24)
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  • Nurse Reviewer - Home Health

    Elevance Health (Chicago, IL)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
    Elevance Health (03/23/24)
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  • Nurse Reviewer I

    Elevance Health (Palo Alto, CA)
    …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... state(s) required. **Preferred Skills, Capabilities, and Experiences:** + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed… more
    Elevance Health (03/27/24)
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  • Clinical Nurse Reviewer - St. Mary Mercy

    Trinity Health (Livonia, MI)
    …the HMS database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the physician champion and appropriate hospital ... **Employment Type:** Full time **Shift:** Rotating Shift **Description:** HMS collaborative reviewer The Clinical Nurse Reviewer 's chief responsibility is to… more
    Trinity Health (03/27/24)
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  • Chief Medical Office

    Ellis Medicine (Schenectady, NY)
    …include Director of Quality and Risk, Director of Family Medicine Residency Program, Physician Advisor Utilization Management , and System Wide Chiefs. The ... accordance with Hospital Policy and Procedure, and oversight of physician contract management functions. + Serves as...the budgets of the Clinical Departments. + Provides contractual review for and reviews performance of all physicians who… more
    Ellis Medicine (01/03/24)
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  • Executive Medical Director Revenue Cycle

    AdventHealth (Maitland, FL)
    …managed care payers. The Medical Director is responsible for providing physician review of utilization , claims management , and quality assurance related ... need.Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and maintain a positive… more
    AdventHealth (02/17/24)
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