- Mindlance (Philadelphia, PA)
- Responsibilities: Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and ... metrics in a fast-paced environment. The Clinical Care Reviewer - Utilization Management...assess patient cases. Strong understanding of utilization review processes, including medical necessity criteria, care … more
- HireMaster (Lincoln, NE)
- …Ensures appropriate resource utilization relevant to the financial, regulatory and clinical aspects of care ; proposes alternative treatment to ensure a cost ... Minimum of two (2) years recent clinical experience required. Prior care coordination and/or utilization management experience preferred. OTHER CREDENTIALS /… more
- Novo Nordisk Inc. (East Cleveland, OH)
- …guidelines, chronic care models, protocols, etc. to engage HCPs in clinical conversations to appreciate how they manage patients with diabetes and where they ... the opportunity to help people with obesity receive the care they deserve. The Novo Nordisk aspiration is to...maintain advocacy of customers aligned to company, brand and clinical goals. The OCS develops local strategies and executes… more
- Novo Nordisk Inc. (Detroit, MI)
- …guidelines, chronic care models, protocols, etc. to engage HCPs in clinical conversations to appreciate how they manage patients with diabetes and where they ... Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious...Representative also assists their target physicians with their local clinical and educational initiatives by coordinating company resources (eg,… more
- Optum (Portland, ME)
- …maintains collaborative relationships with all members of the healthcare team. Through clinical care coordination drives efficient utilization of resources ... Whether you are looking for a role in a clinical setting or supporting those who provide care...Maintains a working knowledge of care management, care coordination changes, utilization review … more
- University Health (San Antonio, TX)
- …recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. ... Works with more difficult/complex patients, promoting the achievement of optimal clinical and resource utilization allocation; facilitates transitions to… more
- JobAdX (Smyrna, TN)
- About this role: As a Clinical Manager with Fresenius Medical Care , you will ensure that quality patient care is delivered while maintaining clinical ... will be part of a close-knit, collaborative team responsible for delivering unique care plans and providing dialysis treatment to patients facing end stage renal… more
- Novo Nordisk Inc. (Greensboro, NC)
- …who need them most. At Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious chronic conditions such as obesity, ... health centers, HCPs and other stakeholders in a given geography. Utilizing approved clinical resources to support provider efforts to deliver appropriate care … more
- JobAdX (Dubois, PA)
- …or federal surveys.Participates in the completion of the FMS Administrative Clinical Review .PHYSICAL DEMANDS AND WORKING CONDITIONS:The physical demands and ... all regulatory and FMS policy requirements. Ensure provision of quality patient care while maintaining cost-effective clinical operations in accordance with all… more
- Novo Nordisk Inc. (San Francisco, CA)
- …years experience in a health-related system, pharmaceutical company, or managed care environment required Relevant clinical and/or therapeutic experience ... About the Department The Clinical , Medical and Regulatory (CMR) department at Novo...most diverse and collaborative groups within the organization. From health- care -provider interactions and developing and implementing regulatory strategies with… more
- Gentle Dental (El Segundo, CA)
- …across all regions and specialties. Lead efforts to standardize and improve clinical protocols, treatment planning, and patient care practices. Partner with ... clinical operations, including scheduling optimization, patient flow, and chair utilization . Ensure alignment between clinical and operational priorities to… more
- Eisai, Inc (Nutley, NJ)
- …provides to patients, their families, and caregivers is Eisai's human health care (hhc) mission. We're a growing pharmaceutical company that is breaking through ... regional medical directors and MSL leadership, Publications, Medical Communications, Clinical Development, Biostatistics, Field HEOR, Patient Advocacy, and other… more
- ADELANTE HEALTHCARE INC (Buckeye, AZ)
- …health outcomes reporting, clinical audits, and programmatic evaluation Help evaluate clinical care , utilization of resources, and development of new ... Position Type Full Time Education Level Bachelor's degree Job Category Health Care Description POSITION SUMMARY This on-site outpatient Registered Dietitian will be… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …the marketplace, with targeted payer accounts that influence patient access and care . Targets include a range of influential stakeholders and decision makers, ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
- Contra Costa County, CA (Martinez, CA)
- …Health Services? The Contra Costa Health Department is seeking to fill one (1) Utilization Review Manager position in Contra Costa Health Plan, located in ... business. We are seeking a strategic, experienced, and collaborative Utilization Review Manager to lead our ...will typically be responsible for: Managing and monitoring day-to-day clinical review operations and authorizations Leading the… more
- Geisinger (Elysburg, PA)
- …top-notch care in an ambulatory setting.? Job Duties Provides direct patient care and clinical support for physicians and other providers in the outpatient ... Job Title: Certified Medical Assistant-CMA- Primary Care Location: Elysburg, Pennsylvania Job Category: Patient Support,... team under the direction of the provider. Performs clinical duties such as preparing patients, collecting and reviewing… more
- NCH Healthcare System (Naples, FL)
- …improvement activities relevant to identified opportunities. . Actively collaborates with utilization review team to facilitate and meet organizational and ... responsible for participating in the development of the patient's plan of care and facilitating efficient throughput, ensuring appropriate utilization of… more
- Baton Rouge General (Baton Rouge, LA)
- …shapes the future of patient care through resourceful and compassionate utilization review ? What We're Looking For: Strong leadership and advocacy abilities ... a track record of team support and development Minimum 3 years of hospital utilization review experience preferred At least 1 year of supervisory experience… more
- Pharmacy Careers (Glendale, AZ)
- Formulary Strategy & Utilization Review Pharmacist Shape the drug benefit landscape-analyze and optimize medication use. Key Responsibilities: Review ... DUR and prepare stakeholder reports. Qualifications: PharmD with managed care , DUR, or pharmacy benefit experience. Strong Excel/data analytics background… more
- Geisinger (Scranton, PA)
- …Medicine Team Date Posted: 04/28/2025 Job ID: R-77601 Job Summary Provides direct patient care and clinical support for physicians and other providers in the ... Job Title: Certified Medical Assistant - Express Care Location: Scranton, Pennsylvania Job Category: Patient Support,... team under the direction of the provider. Performs clinical duties such as preparing patients, collecting and reviewing… more
