- UPMC (Pittsburgh, PA)
- …out this fantastic new opportunity! UPMC Health Plan is hiring a full-time Telephonic Care Manager to support the Medicare line of business within the Allegheny ... hours, Monday through Friday with occasional evenings and weekends required. The Telephonic Care Manager is responsible for care coordination and health education… more
- ICW Group (Pleasanton, CA)
- …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
- Access Dubuque (Dubuque, IA)
- …consumers, ensuring quality outcomes and cost-effective treatment. **Key Responsibilities:** + Provide telephonic case management and utilization review for ... + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:** Strong communication,… 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
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would be managing a… 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
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provides telephonic or outpatient visits to patients at high-risk for...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… 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
- 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
- CareOregon (Portland, OR)
- …and resources. Areas of oversight include prior authorizations, referrals, concurrent review , and durable medical equipment (DME). This includes the development and ... fulfilling established goals and objectives. + Develop and implement utilization programs and services to ensure the use of...Facilities/Security ☐ Outdoor Exposure Member/Patient Facing: ☒ No ☐ Telephonic ☐ In Person Hazards: May include, but not… more
- Highmark Health (Salem, OR)
- …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
- Actalent (Tampa, FL)
- … review experience and/or discharge planning. + At least 2 years of utilization review /management experience. + 1 year of experience within Case Management or ... issues to the supervisor for resolution. + Conduct scheduled telephonic touchpoints with facility personnel to review ...clinical experience in a clinical setting. + Knowledge of Utilization Management and URAC & NCQA standards. + Broad… more
- Albany Medical Center (Albany, NY)
- …the RN may provide direct patient care, patient triage (in-person and telephonic ), assessment, planning, directing and evaluating of a patient's specific care plan ... or APP and documents results in EHR * Performs review and triage of incoming test results, patient requests...facilitates call-backs to patients as necessary * Facilitates the utilization of resources to meet patient outcomes and contribute… more
- Matrix Providers (Fairfield, CA)
- …Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... facility treatment team referrals. Facilitates identification, adoption, implementation and utilization of standardized clinical practice guidelines and protocols for… more
- CVS Health (Topeka, KS)
- …Spanish. **Preferred Qualifications** + Crisis intervention skills preferred + Managed care/ utilization review experience preferred + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. + … more
- CommonSpirit Health (Phoenix, AZ)
- **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
- ChenMed (Philadelphia, PA)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... assist in achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from admission through… more
- CareOregon (Portland, OR)
- …financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, ... forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. This position… more
- CareOregon (Portland, OR)
- …financial sustainability efforts. Areas of analysis include cost and utilization trend analysis, return on investment evaluations, Medicare bid development, ... forecasting support, benchmarking, risk adjustment optimization, provider payment evaluation and review of actuarial estimates such as IBNR and PDR. Essential… more
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