- Humana (Indianapolis, IN)
- …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
- State of Indiana (Indianapolis, IN)
- …three (3) years of staff management and evaluation experience; clinical experience in managed care and accredited utilization management experience ... This role provides direct supervision for one or more staff members. The ideal candidate for this role will...provides the skills needed to conduct oversight of all utilization management practices and clinical … more
- Humana (Indianapolis, IN)
- …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
- CenterWell (Avon, IN)
- …for review of the appropriate number of Case Managers and clinical staff documentation to include starts-of-care, resumption-of-cares, and re-certifications, ... documentation in addition to feedback and recommendations by Utilization Review staff . Upon completion of the...systems and process. Competently performs patient care assignments and staff management activities. + Provides direct patient… more
- Fresenius Medical Center (Clarksville, IN)
- …as a resource to facility staff . + Provides counseling for all clinical staff members at regular intervals offering support and encouraging professional ... to the disease management company. Maintains current knowledge of disease management software and systems as pertinent. ** STAFF :** + Responsible for… more
- Highmark Health (Indianapolis, IN)
- …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
- Humana (Indianapolis, IN)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... communicating with staff in different positions and all levels of management positions + Manages the Humana Michigan FIDE-SNP health plan relationship with our… more
- Trinity Health (Mishawaka, IN)
- …of all Service Line activities as appropriate. + Assures that direct care staff , all relevant clinical disciplines, including physicians, are included in PI ... Type:** Full time **Shift:** Day Shift **Description:** The Executive Director of Clinical Operations, Maternal Child and Inpatient Services at Saint Joseph's Health… more
- CVS Health (Indianapolis, IN)
- …each and every day. The supervisor is responsible for oversight of healthcare management staff including the organization and development of high performing ... teams. Works closely with functional area management to ensure consistency in clinical interventions...experience as a Registered Nurse - 1+ years of Utilization Management experience - Must have experience… more
- Evolent (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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 (Indianapolis, IN)
- … 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
- Community Health Systems (Fort Wayne, IN)
- …with all policies and standards. **Leadership Responsibilities** + **Supervision and Staff Management ** + Provides leadership, mentorship and professional ... is responsible for the planning, coordination, and oversight of care management services, including utilization review, discharge planning, and transitions of… more
- Elevance Health (Indianapolis, IN)
- …benefits plans will require guidance from leadership, medical directors or delegated clinical staff . + Conducts and may approve pre-certification, concurrent, ... or equivalent. Requires a minimum of 6 years of clinical experience and/or utilization review experience. +...Experiences:** + Prior claims experience is strongly preferred. + Utilization Management experience is strongly preferred. +… more
- Highmark Health (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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 (Indianapolis, IN)
- …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