- Kepro (Indianapolis, IN)
- …partner for health solutions in the public sector. Acentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job ... Summary: Our Utilization Management Appeals Nurse - LPN/RN will...based on clinical review, criteria, and organizational policies to physician reviewers for final determination. + Resolves complex and… more
- Elevance Health (Indianapolis, IN)
- **Clinical Operations Medical Director** ** Utilization Management of Medical Oncology Benefits** **Carelon Benefits Management ** **$20,000 Sign On Bonus** ... proud member of the Elevance Health family of companies, Carelon Medical Benefits Management , formerly AIM Specialty Health, is a benefit- management leader in… more
- Prime Therapeutics (Indianapolis, IN)
- …MRx - Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… more
- Evolent Health (Indianapolis, IN)
- …Vascular Surgery, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Evolent Health (Indianapolis, IN)
- …Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Highmark Health (Indianapolis, IN)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... Therapeutics Committee review. + Assist in the development and implementation of utilization management programs including but not limited to: prior… more
- Intrepid USA (Avon, IN)
- …rules and physician orders + Responsible for efficient and effective utilization management in accordance with client needs, physician orders ... and training to caregiver staff and assures compliance with documentation and physician order requirements. The DOPS must be accountable for adherence to company… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Humana (Indianapolis, IN)
- …interpretation skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- CenterWell (Indianapolis, IN)
- …care plans and interpreting patient needs, while adhering to Company, physician , and/or health facility procedures/policies. + Manages the assignment of caregivers. ... review of clinical documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates and conducts… more
- Elevance Health (Indianapolis, IN)
- …care system including but not limited to health care economics, health care delivery, utilization management , case management , utilization review, health ... the Elevance Health family of companies, Carelon Medical Benefits Management , is a benefit- management leader in Illinois....insurance, government programs etc. + 5-10 years leading physician teams in either payor or managed care organizations.… more
- Elevance Health (Southport, IN)
- …**RN Case Manager** **(LTSS Service Coordinator- RN)** is responsible for overall management of member's case within the scope of licensure; provides supervision and ... face-to-face clinical assessments for the identification, evaluation, coordination and management of member's needs, including physical health, behavioral health,… more
- Community Health Network (Indianapolis, IN)
- …Oncology Department Oncology Product Line Schedule Full-time Facility Community Physician Network Indianapolis Northside 1 Indianapolis, IN 46256 United States ... (Required) * Provider Relations: Works in coordination with Product Line and Physician Leadership to ensure Provider staffing meets the budgeted volumes. Works as… more
- Fresenius Medical Center (Indianapolis, IN)
- …in contracted hospitals/facilities and ensure efficient patient scheduling and staff utilization in accordance with the TAP scheduling tool. + Maintain and ... + Assess daily patient care needs and communicate concerns to attending physician . Implement changes in patient care/treatment as directed and in collaboration with… more
- Fresenius Medical Center (Indianapolis, IN)
- …Classification of Disease (ICD) coding. + Manages clinic financials including efficient utilization of supplies or equipment and regular profits and loss review. + ... scheduling and payroll. PHYSICIANS: + Facilitates the application process for physician privileges and compliance with Fresenius Medical Care Medical Staff By-Laws.… more
- Community Health Network (Indianapolis, IN)
- …of care for the patient. - Establishes the discharge plan with the patient, physician , and care management team for identified patients. - Implements the ... PRN Job Ref 2403429 Category Nursing Job Family Case Manager Department Case Management Schedule Per Diem Facility Community Hospital South 1402 E County Line Rd… more
- Sharecare, Inc. (Indianapolis, IN)
- …other members of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality ... the participants and their Primary Care Provider according to the disease management program intervention guidelines. An RN is supervised by an Operations Manager… more
- Lincoln Financial Group (Indianapolis, IN)
- …industry experience preferred * Experience and/or proficiency with Disability Management (STD/LTD) knowledge, Workers Compensation, Utilization Review and/or ... this role you will provide coaching and guidance to claims regarding medical management **What you'll be doing** * Evaluate medical information to clarify diagnoses,… more
- Elevance Health (Indianapolis, IN)
- … physician , hospital and ancillary network contract negotiation strategies, utilization management efforts, new products, annual benefit design participation, ... of care initiatives, negotiates for human capital resources, and partners with care management , claims, IT, and business partners. + Manages and presents cost of… more