- 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
- UnitedHealth Group (Seattle, WA)
- …3+ years of experience working in acute care 1+ years of care management, utilization review or discharge planning experience HMO experience ... appropriate utilization of resources and patient quality outcomes. Performs care management functions on-site and telephonically as the need arises. Works in… more
- Novo Nordisk Inc. (San Diego, CA)
- …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
- 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
- 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. ... POSITION SUMMARY/RESPONSIBILITIES Coordinates the interdisciplinary treatment plan of care for patients across the healthcare continuum within a defined population.… more
- Ochsner Health (Gretna, LA)
- …health, managed care , care management, case management or utilization review .CertificationsRequired - Current registered nurse (RN) license in state of ... effort to elicit changes in processes for patients navigating the continuum of care .Collaborates with leadership to review processes with the goal of improving… 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
- buyer (New York, NY)
- …appropriate services and other resources to assist in goal achievement. Conduct Utilization Review for designated Case Management members for some diversionary ... day hospital programs. Conduct initial and ongoing Behavioral Health clinical assessments. Develop a formal plan of care...Review and Approve submitted Health Home Plans of Care and ensure that CMA's are conducting timely annual… 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
- buyer (Tinton Falls, NJ)
- …in Wound Rounds, Operations Meetings, Utilization Review , and Performance Improvement/Risk Management/Safety (PI/RM/S) Committee.Reviewing clinical ... existing ones!.How you will make an impactLeading and mentoring a team of clinical staff members, ensuring Erickson's Person-Centered Care approach, and creating… 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
- Health eCareers (Los Angeles, CA)
- The Medical Director of Case Management and Utilization Review leads the hospital specific execution of the Case Management (CM) and Utilization Management ... escalation of care delays, particularly related to clinical care , physician decision making, and patient...for prior authorizations creating discharge delay. Case Management and Utilization Review : Supports the overall enterprise of… 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
- TrackFive (Atlanta, GA)
- …of outcomes; planning; implementation and evaluation) in the performance of clinical care using evidence base practice, uses analytical/critical thinking ... performance improvement inclusive of all stakeholders, research and research utilization to promote safe, quality patient care ...English language optimize the use of technology to support clinical care and holds basic computer skills… more
- TrackFive (Miami, FL)
- …accordance with the NFRMC Utilization Review Plan and managed care contractual agreements. Submits clinical information to insurance companies to ensure ... all needs (ie, physical, psycho-social, financial). Participates in IDT rounds, Conducts utilization review , evaluates clinical information, and communicates… 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
- 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 (San Diego, CA)
- …Behavioral Health* Home Health* Hospice* Insurance Company* Long Term Acute Care /Rehab/Skilled Nursing* Case Management/ Utilization Review Admission Criteria ... Discharge Planning Disease management* Needs Assessment/ Order DME Plan of Care Prior Authorizations Utilize InterQual Criteria* Worker's comp case management* Acute… more
- TrackFive (Cambridge, MA)
- …MA is seeking its next amazing RN (Registered Nurse) to work in Case Management ( Utilization Review ). Read on if this sounds like your perfect fit! Nurses and ... the industry's best recruiters, we offer tons of high-paying jobs, clinical support, and incredible benefits, including: A compensation package that reflects… more
