- Humana (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Baystate Health (Springfield, MA)
- …- Maximum $46.22 - $53.13 - $62.85 **Per Diem Hospital Case Manager / Utilization Management ** The **RN Hospital Case Manager** is a registered nurse responsible ... for transitions + Leads the team to ensure appropriate utilization of patient resources and directs care to other...Work Experience:** + BSN Strongly preferred + 3-5 years clinical Nursing experience + Hospital Case Management ,… more
- Fresenius Medical Center (East Hartford, CT)
- …a frequency determined by Clinical Quality leadership. Collaborates with facility management staff to evaluate the effectiveness of the facility QAPI Program ... development and other meetings as appropriate. Collaborates with appropriate management staff as needed to achieve effective...+ 3+ years dialysis experience required + 3+ years management experience in a clinical leadership role… more
- Hartford HealthCare (Manchester, CT)
- …as evidenced in Individualized Educational Plan, by feedback from MD and clinical staff and supervisor observation. 6. Consistently implements and modifies ... any student in crisis. Documents and communicates pertinent information to educational staff and Clinical Treatment Team. This position maintains contact with… more
- Highmark Health (Hartford, CT)
- …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
- Hartford HealthCare (Hartford, CT)
- …the hospital and surgeons' office record systems. . Works in collaboration with both clinical and administrative staff across the program to ensure accurate data ... specialties. The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection,… more
- Humana (Hartford, CT)
- …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 (Springfield, MA)
- …nutrition resource. **What you will do:** + Supervises the day-to-day activities of the clinical nutrition and diet office staff to ensure efficient operation of ... family, bringing compassionate care to our communities. **Position Purpose:** The Clinical Nutrition Supervisor, under the direction of the Mercy Director Food… more
- Evolent (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- … 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 (Hartford, CT)
- …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
- Genesis Healthcare (Enfield, CT)
- …oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification is overseen by a licensed ... oversight related to case management , quality improvement, care planning, clinical utilization , and patient identification is overseen. Qualifications * They… more
- Evolent (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- …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 (Hartford, CT)
- …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
- Baystate Health (Springfield, MA)
- …the facilitation of accurate patient placement into the health system based on clinical relevance, with integration of care management skills to support ... management as outlined in the evidence based practice guidelines + Uses Utilization Analysis / Management principles, insures that patient's site of care… more
- Evolent (Hartford, CT)
- …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