- Alameda Health System (San Leandro, CA)
- …identified fields in EHR. 17. Maintains current knowledge of clinical practice and Utilization Management by literature review , membership in a professional ... Clinical Nurse III, Acute Inpatient Behavioral Health Utilization Management + San Leandro, CA...(Alameda Health System) and Behavioral Health Department Alameda County Utilization Review Plan to obtain authorization of… more
- Katmai (Fort Carson, CO)
- **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the ... care standards for appropriate utilization of services. Perform utilization management / review for medical necessity for specialty referrals and… more
- Katmai (Fort Carson, CO)
- …(BSN) is required. + Minimum of two (2) years of prior experience in Utilization Management . + Must possess a current, active, full, and unrestricted Registered ... background checks. **DESIRED QUALIFICATIONS & SKILLS** + Certification by a Utilization Management -specific program such as Certified Professional in Healthcare… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …an experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage their specialization ... In addition, they will support clinical programs (disease and case management ), as well as the review and adoption of health plan developed review criteria.… more
- BeOne Medicines (San Mateo, CA)
- …Resource Management will lead the end-to-end global budget & resource management / utilization within GCO including the development of the Annual Operating ... team on resource-related decisions, including prioritization, hiring, and FSP vendor utilization . + Lead cross-functional resource review forums to optimize… more
- ERP International (Luke AFB, AZ)
- … Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health ... CM software, and databases for community resources. - Integrate CM and utilization management (UM) and integrating nursing case management with social work… more
- Rady Children's Hospital San Diego (San Diego, CA)
- …Degree in Nursing 4 years nursing in an acute hospital or 2 years Case Management , Utilization Review , or Discharge Planning experience in an acute hospital ... coordinating discharge needs, quality of care, and implementing the utilization management process for acute inpatients. Case... process for acute inpatients. Case Managers perform concurrent review and denials management based on acute… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …appropriate procedure and diagnosis codes, and support business decisions regarding utilization management activities and guidelines. + Support medical policy ... and diagnosis codes for company medical policies and UM ( Utilization Management ) guidelines that reflect medical necessity, experimental/investigational… more
- Katmai (Fort Carson, CO)
- …providers and ancillary healthcare workers. + Apply principles of utilization review (UR) and utilization management (UM) in processing specialty ... + Review collected data to identify areas requiring intensive management . Analyze data collected and prepare reports describing resource utilization … more
- Commonwealth Care Alliance (Boston, MA)
- …member experience. - Address provider inquiries related to care coordination, utilization management , and program participation, collaborating with internal ... does not have direct reports. Essential Duties & Responsibilities: Provider Relationship Management - Serve as the primary relationship manager and point of contact… more
- Stanford Health Care (Palo Alto, CA)
- …initiatives and guidance for product evaluation teams. + Train Value Based Management committee members to analyze and review data effectively during ... trends within health care and academic medical centers that may impact product/service utilization or Value Based Management processes. + Collaborate with key… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... continuous care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and… more
- Home Depot (Phoenix, AZ)
- …+ Organized Retail Crime elements and law enforcement partnerships + Utilization / management of physical security and investigations systems (CCTV, Alarm, ... of the Merchandise Protection Standards (MPS), Pick Ticket, and Lockup programs. Review Front End Accuracy standards to include Accuracy/Theft and Fraud initiatives… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …as part of a core team. You'll collaborate cross-functionally with care management , utilization management , provider/member relations, and market-facing ... populations.? **What** **you'll** **do:** + Develop oncology drug class specific management strategies including but not limited to trend forecasting & monitoring,… more
- Carnegie Mellon University (Pittsburgh, PA)
- …Provide analytical support and financial insight for audits, facilities projects, space utilization , grants management , and special projects. + Coordinate with ... + Coordinate with grant and contract accounting, including pre-award budget review , post-award expense tracking, effort reporting, and closeout. + Coordinate with… more
- Katmai (Usaf Academy, CO)
- …all levels of health care management to include outside agencies. Performs utilization management activities to optimize cost, quality, and access to care. ... and employ safe work habits. + Utilize available information management systems in daily practice for patient care and...facility staff members to facilitate patient care. + Accurately review and confirm completeness of patient chart and report… more
- Luke Staffing (Agana Heights, GU)
- …professional clinical standards and clinical protocols. . Participate in Utilization Management /Case Management meetings to review and identify . ... of newly assigned unit personnel. . Collaborate in the review of unit standing operating procedures. . If directed,...Manager(s) in the development and implementation of the Case Management Program (CMP). . Develop local strategies that use… more
- Stanford Health Care (Palo Alto, CA)
- …with minimal directions. + Understand and respond to multiple personalities and work/ management styles. + Resource management / utilization knowledge in ... The ORNP works with the PIs on the assessment, management , and coordination of research patient care across the...site visits and study close-outs; and collaborates on the review of documentation during protocol audits. + Develops protocol… more
- Somatus (Mclean, VA)
- …Integrity Product Areas:** Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review **Product Management ** + **Build** business cases ... our mission. Responsibilities **The Impact** **You'll** **Make:** + **Lead** performance management tied to key metrics and business drivers that inform strategic… more
- Stanford Health Care (Menlo Park, CA)
- …management services, which includes strategic planning, financial performance management , resource utilization , contract administration, operational metrics, ... and deliverables. + Collaborates with and provides recommendations to management related to department policies, procedures, business development opportunities,… more
