- Novo Nordisk Inc. (Walnut Creek, CA)
- …trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved clinical and scientific information and insights with target ... ) and key customers. Relationships Externally, the Specialty Field Sales Representative maintains relationships with physicians, pharmacists, nurses, and other key… more
- Merck & Co. (Rahway, NJ)
- …characterize disease burden and epidemiology, treatment patterns, healthcare resource utilization and costs, physician and patient satisfaction surveys, clinical and ... in value evidence teams and serves as outcomes research representative on cross-functional regional and global teamsCritically assesses drivers and… more
- Commonwealth Care Alliance (Boston, MA)
- …, procedures, and facilities under the provisions of CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ... and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a key role in ensuring CCA meets CMS… more
- Monroe Plan for Medical Care (Rochester, NY)
- Utilization Management Intake Representative II Summary Title: Utilization Management Intake Representative II ID:UM 42 (ROC) Location:Rochester, ... are currently looking for an experienced and qualified, Intake Representative for our Utilization Management ...CO Department. + Identifies opportunities to improve processes and services . Shares with management issues that are… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative II** **Location : Virtual -** This role enables associates to work virtually full-time, with the exception of ... days per week will be during these hours.** The ** Utilization Management Representative II** is...impact :** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Elevance Health (FL)
- ** Utilization Management Representative III** **Location:** This role enables associates to work virtually full-time in Florida, with the exception of ... 6 am - 6 pm EST including weekends. The ** Utilization Management Representative III** is...services outside of initial authorized set. + Assisting management by identifying areas of improvement and expressing a… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person ... accommodation is granted as required by law._ " The ** Utilization Management Representative I** will...an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- UNC Health Care (Hendersonville, NC)
- …management referrals. Initiates appropriate social work referrals. + Performs utilization management assessments and interventions, using collaboration with ... with the Care Manager to manage level of care transitions & appropriate utilization of services . Coordinates with the appropriate staff/payers to assure third… more
- Saratoga Hospital (Saratoga Springs, NY)
- …Utilizes MCG- Milliman criteria to identify severity of illness & intensity of service for appropriate utilization management and 1st level criteria ... Care Management Representative Location: Saratoga Hospital, 211...coordination, comprehensive discharge planning, daily rounding with interdisciplinary team, utilization review/ management , readmission avoidance action plan strategies,… more
- Brockton Hospital (Brockton, MA)
- …Develops, implements and evaluates the strategic plan for the organization-wide Case Management system and process for all services across Signature Healthcare. ... the discharge plan; ensures efficient and effective delivery of patient care services through the appropriate utilization of healthcare resources. Participates… more
- Sharp HealthCare (Coronado, CA)
- …regulations. ICD-9, RVS, and CPT 4 coding. + Basic computer functions. + Basic utilization management . + Accurately type or on-line key 35-40 wpm. + Organize ... utilization .Informs appropriate leadership, staff, other departments and/or material management of case needs. + Department productionPatient/families are always… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- Logan Health (Kalispell, MT)
- …ensuring seamless coordination of services for optimal patient outcomes. Inpatient Utilization Management + Manage and review inpatient services to ... Join Our RN Case Management Team and Help Patients Take the Next...for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind |… more
- Cedars-Sinai (CA)
- **Job Description** The Senior Patient Service Rep is responsible for positive patient relations, accurate telephone communication, appointment scheduling, ... workflows. + As liaison coordinates administrative support activities including facilities management , patient billing, utilization management , quality … more
- Cedars-Sinai (Los Angeles, CA)
- **Job Description** The Senior Patient Service Rep is responsible for positive patient relations, accurate telephone communication, appointment scheduling, ... workflows. + As liaison coordinates administrative support activities including facilities management , patient billing, utilization management , quality … more
- Logan Health (Kalispell, MT)
- …ensuring seamless coordination of services for optimal patient outcomes. Inpatient Utilization Management + Manage and review inpatient services to ... for all. Our Vision: Reimagine health care through connection, service and innovation. Our Core Values: Be Kind |...looking for a PRN RN to join our Case Management Team! Located in scenic Northwest Montana, Logan Health… more
- Wolters Kluwer (Dallas, TX)
- …efforts, prioritizing efforts and resources for assigned customer portfolio. + Ongoing Utilization Management + Oversee and analyze customer utilization ... plays a high-impact role in managing strategy and product utilization across the CDSP product portfolio. They serve as...exceeded and that renewals are achieved. + Customer Relationship Management + Partner with Sales to build and maintain… more
- Parkview Health (Fort Wayne, IN)
- …two years of comprehensive experience in managed healthcare, provider relations, utilization management or physician office experience Other Qualifications Must ... the maintenance and management of provider contracts for Health Plan Services (HPS). Investigates and resolves concerns from providers, including but not limited… more
- State of Colorado (Pueblo, CO)
- …pages. Maintains the Standard Operating Procedure for abstracting and scanning Utilization Management Authorizations for Third Party Payer Reimbursement: + ... Full Time Job Number IIB 00861 7/31/2025 Department Colorado Department of Human Services Division OBH - CMHIP Opening Date 07/31/2025 Closing Date 8/14/2025 11:59… more
- Trinity Health (Ann Arbor, MI)
- …(pre-certifications, third-party authorizations, referrals) and contacts physicians and Case Management / Utilization Review personnel, as needed. Obtains and ... patient care. Identifies required forms or templates based on the types of services patients will receive. At point of service , performs insurance eligibility… more
