- Humana (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …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
- KPH Healthcare Services, Inc. (Oklahoma City, OK)
- …With Us! (https://kphcareers-kphhealthcareservices.icims.com/jobs/15163/ clinical - staff -pharmacist/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336031866) ... in training and orientation of new employees. + Provides technical and clinical information and communicates results of monitoring activities to patients, nurses and… more
- Highmark Health (Oklahoma City, OK)
- …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
- Evolent (Oklahoma City, OK)
- …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
- Prime Therapeutics (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- … 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 (Oklahoma City, OK)
- …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 (Oklahoma City, OK)
- …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
- Parexel (Oklahoma City, OK)
- …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
- Evolent (Oklahoma City, OK)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Oklahoma City, OK)
- …Doing:** As a Cardiology, Field Medical Director 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
- Evolent (Oklahoma City, OK)
- …As a Field Medical Director, MSK Surgery you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. Collaboration Opportunities: + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Oklahoma City, OK)
- …Doing:** As a Field Medical Director, Oncology, 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
- Oracle (Oklahoma City, OK)
- …user efficiencies, improved care coordination, reduced readmissions, increased access and utilization , and enhanced clinical workflows. * Training & Education: ... achieving health network goals. Key Responsibilities: * Client Consultation & Relationship Management : o Serve as the strategic lead for client engagements, working… more
- Highmark Health (Oklahoma City, OK)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level… more
- Oracle (Oklahoma City, OK)
- …+ **Informatics and Strategy** : Work as intermediaries between IT professionals and clinical staff , ensuring that technological changes align with clinical ... providers, nurses, and pharmacists. This role requires a unique blend of clinical expertise, leadership, informatics, change management , and data science skills.… more
- Highmark Health (Oklahoma City, OK)
- …program and project management OR d) management of professional analytic staff in a business, clinical or technology function + 5-7 years of experience ... of various projects and data analysis related to Medical Policy and Utilization Management . **ESSENTIAL RESPONSIBILITIES** + Perform management … more
- Evolent (Oklahoma City, OK)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... Be Doing:** + Practices and maintains the principles of utilization management and appeals management ...policies and procedures. + Documents communications with medical office staff and/or MD provider as required. + Interfaces with… more
- Highmark Health (Oklahoma City, OK)
- …expertise.This may include updating/revising existing medical policies. + Partner with Utilization Management and other operational teams to identify ... incumbent participates in various work-groups and sub-committees as a clinical lead/expert. Trains and orients new staff ...a clinical lead/expert. Trains and orients new staff to the department and policy procedures, and mentors… more