- Merck & Co. (North Wales, PA)
- …prior to headquarters submission (ex-USA)Manages programs (patient support, educational or risk management ) to support appropriate and safe utilization of Our ... communication skills (written and oral) in addition to results-oriented project management skills Preferred experience and skills: Deep clinical expertise… more
- Eisai, Inc (Nutley, NJ)
- …will have the primary role of demand generation by conveying complex clinical information to customers and key stakeholders consistent with the FDA-approved ... ethics and compliance standards. Essential Functions Develop and maintain superior clinical expertise with our brand(s) and disease state/conditions to effectively… more
- Eisai, Inc (Nutley, NJ)
- …exceed sales objectives. This will be accomplished by conveying complex clinical information to customers and key stakeholders regarding FDA-approved indications of ... to secure product access through effective P&T coordination and process management . This individual will also be responsible for fostering key stakeholder… more
- Cambia Health Solutions, Inc (Portland, OR)
- …developing and implementing clinical strategies with respect to formulary management , drug utilization management , peer-to-peer conversations, drug ... projects.General Functions and OutcomesResponsible for delivering high quality pharmacy clinical services for Medication Benefit Management .May be responsible… more
- Cambia Health Solutions, Inc (Portland, OR)
- …developing, and implementing clinical strategies with respect to formulary management , drug utilization management , medication therapy management ... Clinical Pharmacist Consultant Remote in ID,...affordability.General Functions and OutcomesResponsible for delivering high quality pharmacy clinical services for Medication Benefit Management .May be… more
- Cambia Health Solutions, Inc (Renton, WA)
- …performance metrics.Conducts peer clinical review for medical necessity on utilization management authorization requests.Provides clinical input on case ... and development and may participate on committees that develop programs impacting clinical interventions, utilization management and case management… more
- Cambia Health Solutions, Inc (Portland, OR)
- …have a Master's Degree in Behavioral Health Discipline and 3 years of case management , utilization management , disease management , or behavioral health ... making a difference? In this position, you would provide clinical care management to best meet the...(LICSW, LCSW, LMHC, LPC and LMFT). Clinical License must be unrestricted and current in state of residence.#LI- Remote… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …of individual patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to assure ... patient management that efficiently and effectively aligns with patient needs...aligns with patient needs using resources to meet quality, clinical and cost effective outcomes. Coordinates a team approach… more
- Cambia Health Solutions, Inc (Boise, ID)
- …for candidates within Idaho, but the right candidate will be eligible for a remote role within our 4-state footprint (WA, ID, OR, and UT). Primary Job PurposeThe ... and other drug use issues which do not require clinical judgment. This function assists the Clinical ...to providers and members as necessary.Obtains and organizes drug utilization data, including patient specific and population-based data, in… more
- Providence (Seattle, WA)
- **Description** **THE ROLE** The Senior Director Utilization Management & Denials - Administration is 100% remote . The role requires a broad knowledge and ... focus on Utilization Management and Denials principles such as...Direct responsibility and oversight for divisional pre-service and post-service utilization review, clinical claims audit, clinical… more
- Kepro (Los Angeles, CA)
- …partner for health solutions in the public sector. Acentra seeks aUtilization Clinical Reviewer - LCSW/LMFT/LPCC/LCPC ( Remote within California) to join our ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- CVS Health (Frankfort, KY)
- …other internal and external constituents in the coordination and administration of the utilization /benefit management function. + Utilizes clinical skills to ... coordinate, document and communicate all aspects of the utilization /benefit management program. Required Qualifications : + Licensed independent Behavioral… more
- Humana (Oklahoma City, OK)
- …removing barriers to helping people achieve their best health. The Utilization Management (UM) Nurse 2 uses clinical nursing skills to support the ... heart, lung, or critical nursing experience + 1+ yr of experience in Utilization Management + Prior clinical experience, preferably in an acute care, skilled… more
- ProgenyHealth (Elk Grove Village, IL)
- ProgenyHealth is a leading provider of care management solutions for premature and medically complex newborns. Our program promotes appropriate utilization , ... and throughout the first year of life. Job Role Clinical care nurses coordinate overall member care, from pre-admission,...events throughout the year + Role specific - full remote work week ProgenyHealth positively recruits people from diverse… more
- Virtua Health (Pennsauken, NJ)
- …Locations: Job Information: Schedule: Monday - Friday 8:00am - 4:30. This is a remote position but would require going into the office in Pennsauken on an ... processes and maintains required documentation and reports such as productivity/ utilization , medical records, customer surveys, audits, financial reports, staff… more
- Providence (Portland, OR)
- …people, we must empower them._** **Providence Health Plan is calling an Associate Utilization Review Specialist who will:** + Be responsible for all core functions ... in one or more of the following clinical teams: + Prior-authorization (PA) + Concurrent Review (CCR)...call centers, research briefs, provider resolutions) **We welcome 100% remote work for residents who reside in the following… more
- Gentiva (Mooresville, NC)
- …a lasting difference in people's lives every day. **Overview** The ** Utilization Manager** plans, coordinates, implements, and finalizes projects according to the ... processes, and reporting for medical supplies, durable medical equipment, and pharmacy utilization . This role also works closely with branch personnel to identify… more
- CVS Health (Harrisburg, PA)
- …care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate ... can live in Pennsylvania. As a Utilization Management Nurse Consultant, you will utilize clinical ...to coordinate, document and communicate all aspects of the utilization /benefit management program. - Utilizes clinical… more
- Centene Corporation (Raleigh, NC)
- … Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure ... adherence to performance, compliance, quality, and efficiency standards + Collaborates with utilization management team to resolve complex care member issues +… more
- Centene Corporation (Sacramento, CA)
- … Clinical Review team to ensure appropriate care to members. Manages utilization management issues related to member care, provider interactions, and ... changes everything for our 28 million members as a clinical professional on our Medical Management /Health Services...facilitates operations within utilization management . + Manages prior authorization, concurrent… more
