- 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
- 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
- Mohawk Valley Health System (Utica, NY)
- …specialist regarding correct level of care and reimbursement. Apply knowledge of utilization review , discharge planning, patient status changes, length of stay, ... barriers to patient discharge. The Physician Advisor (PA) conducts clinical review of cases to ensure compliance with regulatory requirements, hospitals objectives,… more
- Highmark Health (St. Paul, MN)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the...of service. Depending on the nature of the case, telephonic peer to peer discussions may be required. The… more
- Sharecare (Columbia, SC)
- …and objectives of the Disease Management program by providing high quality telephonic and omni - channel support in an appropriate, efficient and cost-effective ... nurse helps to drive cost effective and appropriate resource utilization and desired clinical outcomes. The Disease Management Nurse...and to take the pre and post tests to review competency during orientation. Yearly competency tests are required… more
- LA Care Health Plan (Los Angeles, CA)
- …and unrestrited California License. Licenses/Certifications Preferred Certified Professional in Utilization Review (CPUR) Certified Case Manager (CCM) Required ... Requirements Light Additional Information Preferred: Certification in Certified Professional in Utilization Review (CPUR), Certified Case Manager (CCM), … more
- Atlantic Health System (Morristown, NJ)
- …the patient experience, achieve better health outcomes, decrease avoidable cost and utilization , and increase the utilization of preventative care and healthy ... needs, values, and goals of the patient. Provide individual telephonic /virtual support and counseling to patients, using appropriate therapeutic techniques… more
- CommonSpirit Health (Englewood, CO)
- **Responsibilities** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred by case management staff and/or other health care ... hospital's objectives for assuring quality patient care and effective and efficient utilization of health care services. This individual meets with case management… more
- CareOregon (Portland, OR)
- …and appeals. + Develop and implement clinical educational programs to improve drug utilization and quality. + Review and refine policies and procedures regarding ... pharmacy program activities as assigned. Essential Responsibilities + Prepare drug utilization reports and analyses for the Pharmacy & Therapeutics Committee. +… more
- UPMC (Pittsburgh, PA)
- …will support Shadyside Family Practice onsite in Shadyside and may provide telephonic support to other practices. The position will work standard daylight hours, ... promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member,… more
- CVS Health (Columbus, OH)
- …and supporting the implementation of Wellness Plans to promote effective utilization of healthcare services. This position promotes/supports quality effectiveness of ... to accommodate business needs. Position Responsibilities: + Responsible for initial review and triage of members. + Manages population health member enrollment… more
- Guthrie (Sayre, PA)
- …leadership and autonomy in nursing practice. Preferred experience with care management/ utilization review , and payer knowledge. Fast paced ambulatory care ... On Bonus For Qualified RNs! Summary: The Care Coordinator-Transitional Care provides telephonic outreach to all patients that have been discharged from an inpatient… more
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