- Blue Cross and Blue Shield of Minnesota (Duluth, MN)
- …1+ years of managed care experience; eg case management/health coach, utilization management and/or auditing experience. Outstanding telephonic skills. Role ... (VPTO) And more To discover more about what we have to offer, please review our benefits page. Equal Employment Opportunity Statement At Blue Cross and Blue Shield… more
- UnitedHealth Group (Chicago, IL)
- …to peer conversations for the clinical case reviews, as needed Conduct provider telephonic review and discussion and share tools, information, and guidelines as ... continental time zones in the US. Primary Responsibilities: Provide daily utilization oversight and external communication with network physicians and hospitals… more
- Baystate Health (Springfield, MA)
- …through face to face visits, home visits if necessary, as well as telephonic interactions. In addition, they will assist with advance directives, palliative care, ... facility/program, emergency room, or from a skilled nursing facility. Responsible to review the discharge summaries, follow up on testing that is pending, ensure… more
- UnitedHealth Group (El Paso, TX)
- …member health care across the care continuum. Primary Responsibilities: Conducting telephonic or face to face holistic evaluations of Member's individual dynamic ... illnesses, co-morbidities, and/or disabilities, to insure cost effective and efficient utilization of health benefit. Assess, plan, and implement care strategies… more
- UnitedHealth Group (Oxford, PA)
- …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 English/Spanish Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In… more
- InGenesis (Columbia, SC)
- …Care II / Social Worker Job Details Professional Discipline : Registered Nurse Specialty : Utilization Review Employment Type : Full Time City : Columbia State : ... Description: InGenesis is currently seeking a Social Worker Case Manager to review and evaluate medical or behavioral eligibility regarding benefits. In this role,… more
- CVS Health (Racine, WI)
- …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
- Reef Systems (Montgomery, AL)
- …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
- Trinity Health (Schenectady, NY)
- …services and available resources. Screening of clients through on site and/or telephonic assessment and record review in collaboration with physicians, nurses, ... or site to the rehabilitation setting Performs on-site and/or record review , including telephone preadmission screening and clinical assessment What you will… 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 (Columbia, SC)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... of our caring community and help us put health first** The Telephonic - UM Administration Coordinator /UM Administration Coordinator 2 provides non-clinical support… 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
- 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
