- Curative HR LLC (Austin, TX)
- …5 years of clinical practice experience. Minimum of 2-3 years of experience in utilization management, medical review , or prior authorizations within an ... outcomes. Contribute to the development, review , and revision of medical policies, clinical guidelines, and utilization management protocols. Participate in… more
- Fort Duncan Regional Medical Center (Eagle Pass, TX)
- …stay), concurrent review , and transitions to prevent readmissions. Liaise with medical staff, utilization review , social services, payors, and community ... rounds. Manage department budget, staffing, and training needs. Function as Utilization Review /Denials Manager as required. Qualifications Registered Nurse (RN)… 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 ... and developing and implementing regulatory strategies with the FDA to providing medical education and collecting data to support efficacy and new product… more
- Valley Health System (Paramus, NJ)
- …activities on all patients within the assigned caseload. Collaborates and educates the medical staff on appropriate utilization review guidelines and ... and Commercial payors guidelines. Monitors and intervenes on LOS, resource utilization and denial management/ prevention within the assigned caseload. EDUCATION:… more
- Eisai, Inc (Nutley, NJ)
- …for internal medical training content. Train new hires on EMAC organization/ utilization .Provide input into and collaborate with regional and global medical ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...MSL managers. Develop congress abstract tracker, assign MSL coverage, review MSL reporting responsibilities, collate and distribute Congress Report,… more
- Novo Nordisk Inc. (Hackensack, NJ)
- …(eg, DBMs, IDBMs, DCSs, IDCSs, Managed Markets Sales Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The EDCS actively shares ... appropriate patients that would benefit in order to ensure early trial and utilization Generate advocacy for Novo Nordisk products and services by sharing approved… more
- Novo Nordisk Inc. (Dayton, OH)
- …live with the disease of obesity, yet only 2% of them receive dedicated medical treatment. By joining the Obesity Commercial team, you will have the opportunity to ... sales and marketing resources to expand the breadth and depth of appropriate utilization Novo Nordisks products, consistent with label and company policy Analyze and… more
- Surgery Partners (Bryan, TX)
- …setting Strong understanding of medical terminology, clinical guidelines, and utilization review processes Proficient in data analysis and interpretation, ... Job Summary: We are seeking a Part-Time Utilization Review Nurse to join our...with payers and documenting relevant information Coordinates clinical care ( medical necessity, appropriateness of care and resource utilization… more
- Novo Nordisk Inc. (Seattle, WA)
- …other field-based employees (eg, DBMs, DCSs, Market Access Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The Specialty Field Sales ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …(Pricing, Contracting, Operations and Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance. External relationships include ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
- Novo Nordisk Inc. (Boston, MA)
- …and Professional Associations. Internally, this position will collaborate with STARS Medical Liaisons, and STARS Account Managers. Essential Functions Attention to ... collateral development Achieve or exceed assigned sales objectives through effective utilization of all available resources, strategies and tactics Collaborates with… more
- Novo Nordisk Inc. (Olathe, KS)
- …proactive collaboration with internal teams such as Sales, Marketing, Market Access, Medical , Legal, and Compliance, contributing to NNI's CM Sales organization and ... and adapting to business priorities Educate HCPs to increase product utilization , optimize treatment, and align with evidence-based medicine and guidelines, while… more
- UHS (Bethlehem, PA)
- …multi-disciplinary team while working in a state-of-the-art facility, including EPIC. The Utilization Review Director is responsible for overseeing the ... utilization review process, ensuring efficient and effective use of healthcare...environment Competitive Compensation & Generous Paid Time Off Excellent Medical , Dental, Vision and Prescription Drug Plans 401(K) with… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... SUMMARY: The System Utilization Management [SUM] Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- AmeriHealth Caritas Health Plan (Philadelphia, PA)
- …judgment, and meaningful collaboration. Lead with Clinical Insight. Whether you're an experienced utilization review nurse, a sharp case manager, or a behavioral ... in EMR systems and meet quality and productivity metrics. Escalate complex cases for Medical Director review as needed. We're Hiring for: General UM (RN):… more
- AmeriHealth Caritas Health Plan (Manchester, NH)
- …impact in our New Hampshire health plan. Responsibilities The Market Chief Medical Officer oversees all utilization review techniques, methods, ... healthcare delivery. We are looking for a Market Chief Medical Officer (CM0) to join our dynamic leadership team...or physician reviewer in a Managed Care Plan preferred Utilization management experience is preferred with a minimum of… more
- American Traveler (Salem, MA)
- …skills for a dayshift inpatient role. Job Details *Work in an inpatient medical /surgical setting with a 200-bed capacity, *Adult patient population with a clinician ... weekend, *Floating to other units is required, *Uses EPIC as the electronic medical record system, Job Requirements *Active Massachusetts RN license required at time… more
- Kaiser Permanente (Los Angeles, CA)
- …the general and specialized principles, practices, techniques and methods of Utilization review /management, discharge planning or case management. Working ... during case review or other activities. Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources… more
- TERRACON (Wichita, KS)
- …daily operations of drilling staff, including training, development, and performance review , utilization of equipment, personnel workload, safety oversight, ... Based on eligibility, role and job status, we offer many programs including medical , dental, vision, life insurance, 401(k) plan, paid time off and holidays,… more
- EvergreenHealth (Kirkland, WA)
- …provides intervention to facilitate patient care in an optimal timeline. Oversees utilization review process including education, support, and training of team ... for equipment, and arrange for additional services in the community. Utilization Management/Case Management Nurses provide clinical information to our payers and… more
