- Corewell Health (Royal Oak, MI)
- …years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred ... patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2.… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …based Medical Liaisons in designated areas of the US Works closely with home office (Medical, Marketing, Sales, Legal, Human Resources) and field personnel. Works ... and people resources, supporting appropriate use of NNI products and greater utilization of its services Takes a leadership role in coordinating activities at… more
- Novo Nordisk Inc. (Olive Branch, MS)
- …to deliver on this aspiration. The team is comprised of both our home office strategy and marketing execution teams and our field based teams focusing ... 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
- Doylestown Hospital (Doylestown, PA)
- …experience in a hospital, insurance company, or independent review company in utilization , quality review , home care or case management. Master level ... and prioritizing skills. Thorough understanding of managed care systems and utilization review criteria. Knowledge of community resources. Demonstrated… more
- Novo Nordisk Inc. (San Diego, CA)
- …appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications Bachelor's or equivalent degree, and/or Pharm… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A Bachelor's degree required Master's degree… more
- Novo Nordisk Inc. (Boston, MA)
- …collateral development Achieve or exceed assigned sales objectives through effective utilization of all available resources, strategies and tactics Collaborates with ... by not exceeding the Novo Nordisk points threshold assigned based on review of Motor Vehicle Records. Qualifications A bachelors degree required Minimum five… 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 ... services. Discover more about us at www.amerihealthcaritas.com. Join a mission-driven Utilization Management team where your clinical expertise helps shape better… 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 ... coordinate post-discharge care. We help coordinate with skilled nursing facilities, home health, hospice, arrange for equipment, and arrange for additional services… more
- Veterans Health Administration (Houston, TX)
- Summary The Registered Nurse Quality & Patient Safety Nurse Manager - Utilization Management functions as a clinical expert and is responsible and accountable for ... qualification standard, please visit https://www.va.gov/ohrm/QualificationStandards/. Preferred Experience: 1-3 years Utilization Management, Nurse Case Manager/Caseworker, and/or Process Improvement Consultant… more
- Blue Shield of California (Oakland, CA)
- …(FEP) membership. These functions include performance of pre-service and retrospective utilization review , Appeals and Grievances, and provider claims dispute ... system in California. The Senior Medical Director FEP Prior Authorization and Post Review will report to the Vice President, Medical Management or their designee. In… more
- Team Select Home Care (West Palm Beach, FL)
- …Control Plan, EMS Plan and the Compliance Plan Participates in clinical record/ utilization review of medical records and quality assurance and performance ... heart, more flexibility, and more purpose? Join Team Select Home Care as a Registered Nurse (RN), where you'll...You'll Do: As a private duty nurse on our home health team, you'll care for medically complex patients,… more
- Team Select Home Care (Atlanta, GA)
- …skills according to established procedures before performing new skills Participates in peer review , utilization review and QAPI activities as assigned ... difference in the lives of families? Join Team Select Home Care , where you'll provide one-on-one care to...grow your career in private duty nursing and long-term home health care, with a supportive team that truly… more
- UnitedHealth Group (Louisville, KY)
- …Qualifications: 1+ years of ICUE experience 1+ years of Linx experience Utilization Management experience Document review experience Managed Care experience Dual ... US as you take on some tough challenges. Primary Responsibilities: Post service review of medical records to determine coverage for mental health and substance use… more
- Actalent (St. Paul, MN)
- Clinical Review Pharmacist (100% Remote) Job Description In this role, you will utilize your clinical skills to conduct utilization management reviews, including ... contracts evaluated every six months for extension. Responsibilities Conduct utilization management reviews, including prior authorizations, coverage exceptions, and… more
- CenterWell Primary Care (Birmingham, AL)
- …review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and ... delivery, and documentation requirements. Responsible for the QA/PI activities. Works with Utilization Review staff relative to data tracking for performance … more
- All County Home Care & Hospice (San Antonio, TX)
- …chaplains and spiritual counselors. Maintains records of spiritual care services utilization and related activities for quality assurance, program development, and ... policies and procedures review and revision. Documents direct services and ongoing communication...of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities… more
- Gandara (Holyoke, MA)
- …vacations Paid holidays 8 discretionary days Mileage Reimbursement Job Title: In- Home Therapy Clinical Supervisor Work Location: Holyoke, MA *Bilingual Candidates ... They will ensure that cases are assigned and closed in a timely manner, review medical charts for quality, ensure workers are providing appropriate and quality care… more
- Hope At Home Health Care (Canton, MI)
- …in peer review and performance improvement as assigned. Participates in utilization review of medical records as assigned. Gives total patient care ... homes. WHY BE A FULL-TIME RN WITH HOPE AT HOME Earn upwards of $100k per year (based on...employees) So become a part of the Hope At Home Family and apply TODAY (serious applicants only)! We… more
- Your Tailor Made Senior Service (Arlington, TX)
- …activities to meet the needs of each individual patient Responsible for evaluating utilization of patient services and patient progress Review evaluation with ... seeking Registered Nurses with prior OASIS/Medicare Certified Visits for Adult home health assignments in Arlington and close surrounding areas. Responsibilities To… more
