- AmeriHealth Caritas Health Plan (Wilmington, DE)
- Role Overview Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the...assess patient cases Strong understanding of utilization review processes, including medical necessity criteria, care … more
- Appcast (Canton, MA)
- …This is Fully remote, but Massachusetts RN license required. Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... for managing a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical… more
- Optum (Portland, ME)
- …maintains collaborative relationships with all members of the healthcare team. Through clinical care coordination drives efficient utilization of resources ... Whether you are looking for a role in a clinical setting or supporting those who provide care...Maintains a working knowledge of care management, care coordination changes, utilization review … more
- Novo Nordisk Inc. (East Cleveland, OH)
- …guidelines, chronic care models, protocols, etc. to engage HCPs in clinical conversations to appreciate how they manage patients with diabetes and where they ... the opportunity to help people with obesity receive the care they deserve. The Novo Nordisk aspiration is to...maintain advocacy of customers aligned to company, brand and clinical goals. The OCS develops local strategies and executes… more
- Novo Nordisk Inc. (Detroit, MI)
- …guidelines, chronic care models, protocols, etc. to engage HCPs in clinical conversations to appreciate how they manage patients with diabetes and where they ... Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious...Representative also assists their target physicians with their local clinical and educational initiatives by coordinating company resources (eg,… more
- University Health (San Antonio, TX)
- …recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. ... Works with more difficult/complex patients, promoting the achievement of optimal clinical and resource utilization allocation; facilitates transitions to… more
- CareOregon (Portland, OR)
- …Implements and oversees effective systems to ensure access, program integrity, quality of clinical care , utilization management, compliance with OARs and ... or managed care organization Experience in Medicaid, quality assurance, utilization review , case management, and/or risk adjustment Experience with… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... provider/academic institutions/ integrated delivery networks, and other key health care provider/organization relationships, specifically with the provision of timely… more
- JobAdX (Green Bay, WI)
- …will be provided with support and extensive leadership training.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 part of a close-knit, collaborative team responsible for… more
- Novo Nordisk Inc. (San Francisco, CA)
- …years experience in a health-related system, pharmaceutical company, or managed care environment required Relevant clinical and/or therapeutic experience ... About the Department The Clinical , Medical and Regulatory (CMR) department at Novo...most diverse and collaborative groups within the organization. From health- care -provider interactions and developing and implementing regulatory strategies with… more
- Novo Nordisk Inc. (Olathe, KS)
- …who need them most. At Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious chronic conditions such as obesity, ... health centers, HCPs and other stakeholders in a given geography. Utilizing approved clinical resources to support provider efforts to deliver appropriate care … more
- Integrated Home (Hollywood, FL)
- …procedures, ineffective treatment, or unnecessarily extensive home healthcare. Concurrent review of patient's clinical information for efficiency Ongoing ... the sole intent of providing the highest quality in-home care services that improve and enhance the daily living...others in any situation Provide updates to Manager of Utilization Management for review What will you… more
- Vivian (Cambridge, MA)
- …hours per weekShift: 8 hours, daysEmployment Type: TravelPrimary Responsibilities:1. Performs utilization review and discharge planning to inpatient admissions ... with attending and house staff when options to inpatient care are identified.4. Utilizes clinical expertise to...care criteria and reports them to the physician reviewer .7. Works with patients and families to facilitate post… more
- MindMatch (Aiken, TX)
- …and safe care in accordance with established standards and plans of care . Utilizes clinical and managerial knowledge and skills, as well as available ... professional accountability for competency and growth. The Registered Nurse Clinical Supervisor assists the DON in some administrative duties,...unable to do so. Assists DON in the proper utilization of personnel assigned to the care … more
- Eisai, Inc (Nutley, NJ)
- …provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission. We're a growing pharmaceutical company that is breaking through ... regional medical directors and MSL leadership, Publications, Medical Communications, Clinical Development, Biostatistics, Field HEOR, Patient Advocacy, and other… more
- TrackFive (Detroit, MI)
- …and promoting staff development. Responsible for the utilization and continued review of patient care protocols, standards of practice, and standards of ... maintaining positive relationships with departments/programs, co-workers and external customers. Provides care in various clinical settings with diverse person's… more
- TrackFive (San Jose, CA)
- …of this role are to include the achievement of optimal health, access to care , and appropriate utilization of resources balanced with the patients' self ... contracted providers and community resources. If assigned to the Emergency Department, the Care Management process is to address complex clinical and social… more
- Orlando Health (Longwood, FL)
- … coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and the transition to ... Accurate medical necessity screening and submission for Physician Advisor review o Care coordination that includes admitting...management, care management, care coordination, utilization management, or acute clinical care… more
- TrackFive (Los Angeles, CA)
- …Required Experience with all patient populations - Required Case Management or Utilization Review Certification - Highly Preferred Benefits: Medical, dental, and ... The PositionSpecialty: RN Case Management Job Details: Responsible for coordinating medical care , and matching patient needs and preference with judicious use of… more
- TrackFive (Kaneohe, HI)
- …monitoring the appropriateness and timeliness of care . Ensures the interdisciplinary care plan is consistent with the patient's clinical course, continuing ... acute care . Discusses with physicians, the appropriateness of resource utilization , consultations, treatment plan, estimated length of stay and discharge plan.… more
