- Corvel (Tallahassee, FL)
- …orthopedics, neurology, or rehabilitation preferred Strong cost containment background, such as utilization review or managed care helpful Certification as a ... The Telephonic Case Manager coordinates resources and creates flexible,...pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department… more
- Cedars Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe Documents appropriate reviews for assigned patients using utilization review tool. Provides telephonic review ... for identified contracted/private patients collaborates with on-site and/or outside reviewers. Keeps patients informed of progress and provides information related to disease progression. Collaborates with discharge planner to make orders and arranges for… more
- Reef Systems (Charleston, SC)
- …4) for telephonic , electronic, and in person access. *Process and review referrals in Government information systems including, but not limited to: MHS GENESIS, ... Staff (ProStaff) meetings. *Identify and notify the Government MTF case manager, Utilization Management (UM) nurse or Primary Care Management (PCM) team, as… more
- Pyramid Consulting, Inc. (Wolfforth, TX)
- …opportunity with long-term potential and is located in Lubbock TX (Remote) . Please review the job description below and contact me ASAP if you are interested. Job ... in the field or you may be working on telephonic follow ups from your home office. We carry...management experience in a managed care setting. Knowledge of utilization management principles and healthcare managed care. Experience with… more
- CVS Health (Chaska, MN)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... when appropriate under the direct supervision of a licensed pharmacist Taking telephonic prescriptions from the prescriber, and calling the prescriber to clarify… more
- Nuvance Health (Poughkeepsie, NY)
- …or BSN preferred. Must have current RN license. Preferred experience in Utilization Review /Management. Location: Vassar Brothers Medical Center Work Type: ... from physiological and economic perspectives. Has overall accountability for the utilization management and transition management for patients within the assigned… more
- UnitedHealth Group (Durham, NC)
- …Experience in discharge planning Experience in utilization review , concurrent review or risk management Experience in a telephonic role Experience in ... home care/home visits Experience working with MS Word, Excel and Outlook Background in managed care Bilingual in English/Spanish *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this… more
- Albany Med (Albany, NY)
- …the RN may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's specific care plan ... and documents results in EHR *Performs venipuncture per order of MD/APP *Performs review and triage of incoming test results, patient requests and pharmacy renewals;… more
- Centene Corporation (Jefferson City, MO)
- …28 million members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various ... the operations of utilization management, reconciliation coordination, concurrent review ( telephonic and on-site), specialty therapy programs and other… more
- Humana (Hallandale Beach, FL)
- …ensure interaction between the company and members are optimized. The Telephonic Behavioral Health Care Manager Internship provides transitioning service members ... requirements to achieve and/or maintain optimal wellness state in a remote telephonic environment. The Behavioral Health Care Manager guides members and/or families… more
- ICW Group (Lisle, IL)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate...Providers. + May perform Utilization Review activities (or review … more
- Access Dubuque (Dubuque, IA)
- …office and is also available remotely within Iowa. **Key Responsibilities:** + Provide telephonic case management and utilization review for assigned ... + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:** Strong communication,… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral health and substance use ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
- Cedars-Sinai (Marina Del Rey, CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review ... for identified contracted/private patients collaborates with on-site and/or outside reviewers. + Keeps patients informed of progress and provides information related to disease progression. + Collaborates with discharge planner to make orders and arranges for… more
- AdventHealth (Altamonte Springs, FL)
- …or medical necessity by securing Independent Medical Examinations or submitting formal Utilization Review with clinical director and claims adjuster approval and ... Develop a comprehensive medical treatment plan based on data collected through telephonic medical interview, assessment and review of medical documentation that… more
- Elevance Health (Louisville, KY)
- …granted as required by law._ This role's primary focus is ABA utilization management The **Manager Behavioral Health Services** is responsible for Behavioral Health ... Utilization Management (BH UM). **How you will make an...cost of care initiatives. + May attend meetings to review UM and/or CM process and discusses facility issues.… more
- CommonSpirit Health (Houston, TX)
- …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more
- Option Care Health (Austin, TX)
- …best and brightest talent in healthcare. **Job Description Summary:** Responsible for telephonic management of patients at the telephonic center. **Job ... homecare nurses, as well as coordination of care with respect to telephonic management and interfacing with patient's physician. + Provide patient education through… more
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
