- Humana (Richmond, VA)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Humana (Richmond, VA)
- …part of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and ... and communication of medical services and/or benefit administration determinations. The Utilization Management Behavioral Health Professional 2 work assignments… more
- Humana (Richmond, VA)
- …Lead- Florida develops, maintains, and/or operationalizes formularies related to coverage, utilization management edits, or clinical coverage policies ... Develops corporate communications to be shared with senior leadership. Supports trend management by conducting analysis of drug spend, utilization , and/or… more
- Highmark Health (Richmond, VA)
- …and financial stakeholders **Preferred** + Experience with medical policy and utilization management functions + Medical coding experience **LICENSES or ... Utilize robust, data-driven insights from complex healthcare datasets (eg, claims, clinical , utilization , pharmaceutical) to inform policy development, identify… more
- Bon Secours Mercy Health (Richmond, VA)
- …regarding associate performance evaluations, delivers performance feedback and coaching to clinical staff to assist with workflow improvement/efficiency + Must ... satisfaction. They also maintain a positive and collaborative relationship within the clinical environment by coaching, developing, and empowering staff . The RN… more
- HCA Healthcare (Richmond, VA)
- …deprovisioning of system access to align with practitioner's membership status and/or clinical privileges. Coordinate access by authorized facility staff to ... regulatory agency reporting of adverse actions taken against a practitioner's medical staff membership or clinical privileges, as directed by facility leaders.… more
- Evolent (Richmond, VA)
- …is responsible for support and assistance for all cardiology administrative and clinical utilization management and quality improvement functions under ... directed by the office of the Chief Medical Officer. + Responsible for clinical conversations with providers and their office staff regarding medical necessity… more
- HCA Healthcare (Richmond, VA)
- …and managing the pharmacy clinical programs in conjunction with the Clinical Manager. This includes formulary management , policy and procedure development ... and integrity. We care like family! Jump-start your career as an Pharmacy Clinical Coordinator today with Parham Doctors' Hospital. **This work schedule is Monday-… more
- HCA Healthcare (Hopewell, VA)
- … Coordinator is responsible for designing, implementing and managing the pharmacy clinical programs. This includes formulary management , policy and procedure ... colleagues invested over 156,000 hours volunteering in our communities. As an Pharmacy Clinical Coordinator with TriCities Hospital you can be a part of an… more
- Bon Secours Mercy Health (Richmond, VA)
- …**Essential Functions:** + Activities may include but are not limited to medication management activities typically for a specific clinical area of focus or ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **_Clinical Pharmacist - St. Mary's Hospital_** **Job… more
- Bon Secours Mercy Health (Richmond, VA)
- …effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Primary Function/General Purpose of Position** The ... Critical Care Clinical Pharmacy Specialist participates in clinical programs...disease prevention + Perform medication reviews and medication therapy management to ensure safe and appropriate use of medications… more
- Prime Therapeutics (Richmond, VA)
- …and timely fashion. + Demonstrates the value of pharmacy solutions (unit cost, utilization management & patient care enhancement). + Identifies opportunities for ... visa or residency sponsorship **Additional Qualifications** + 3-5 years' experience in clinical operations, quality, network, pharmacy or project management OR a… more
- Evolent (Richmond, VA)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks ... independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse… more
- Bon Secours Mercy Health (Midlothian, VA)
- …and partnership + Inter-professional collaboration and leadership + Understanding and utilization of office and clinical technologies + Compassionate, ... Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **_About Us_** As a faith-based...the Advanced Heart Failure Center. + Provide education to staff , patients and families as needs are identified. +… more
- Bon Secours Mercy Health (Mechanicsville, VA)
- …and partnership * Interprofessional collaboration and leadership * Understanding and utilization of office and clinical technologies * Compassionate, ... effectiveness. Our hospitals, care sites and clinicians are recognized for clinical and operational excellence. **Memorial Regional Medical Center** THIS POSITION… more
- Evolent (Richmond, VA)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Highmark Health (Richmond, VA)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Evolent (Richmond, VA)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Elevance Health (Richmond, VA)
- …expert consultation to local plan staff on benefits interpretation and utilization and quality management matters. + Ensures support for compliance with ... you will make an impact:** + Oversees case and utilization management execution/decision making for managed member...health care field and a minimum of 10 years clinical work experience including prior management experience;… more
- Parexel (Richmond, VA)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more