- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... outbound calls to customers (members and providers) by delivering excellent customer-centered service providing information regarding services in a call center… more
- Elevance Health (San Antonio, TX)
- …affordability, and personalized support throughout the consumer's treatment journey. **Title:** Utilization Management Representative II - Prior ... BioPlus offer consumers and providers an unparalleled level of service that's easy and focused on whole health. Through...location. **Build the Possibilities. Make an extraordinary impact.** The Utilization Management Representative II -… more
- Elevance Health (Ashburn, VA)
- ** Utilization Management Representative II** **Location:** Within 50 miles of a Pulse Point location in Virginia or North Carolina. **Hours:** Monday - ... Friday, from 9:30 am - 6:00 pm EST. The ** Utilization Management Representative II** is...an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative II** **Location :** Seeking candidates that reside within 50 miles of the **Atlanta, GA** or **Columbus, GA** ... days per week will be during these hours.** The ** Utilization Management Representative II** is...impact :** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Elevance Health (Houston, TX)
- ** Utilization Management Representative II** **Location:** Within 50 miles of a Pulse Point location. **Hours:** Monday - Friday, 11:30 am - 8:00 pm EST The ... ** Utilization Management Representative II** is...an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Elevance Health (Rocky Hill, CT)
- ** Utilization Management Representative I** **Location:** Within 50 miles of Wallingford or Rocky Hill, Connecticut **Hours:** Monday - Friday, from 8:30 am ... - 5:00 pm EST. The ** Utilization Management Representative I** is...an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Elevance Health (Topeka, KS)
- ** Utilization Management Representative I** **Location:** Within 50 miles of a Pulse Point in Nevada, Kansas, or Texas **Hours:** Monday - Friday, an 8-hour ... hours of 7 am and 6 pm PST. The ** Utilization Management Representative I** is...an impact:** + Managing incoming calls or incoming post services claims work. + Determines contract and benefit eligibility;… more
- Matrix Providers (Aurora, CO)
- …in Handbook) + 401(k) Plan Minimum Requirements Registered Nurse (RN) Utilization Management : Degree/Education: Bachelor-s degree in nursing. Certifications: ... our team of talented professionals who provide health care services to our Military Service Members and...Management through the American Nurses Credentialing Center + Utilization Management Accreditation through National Committee for… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- …preferred Experience: Greater than 3 years clinical nursing experience required. Utilization management experience preferred. Must be self-directed and possess ... clinical expertise with knowledge of medical appropriateness criteria, and applies principles of utilization and quality management , and the management of… more
- Ochsner Health (New Orleans, LA)
- …as well as efficiently in high pressure situations. Preferred- Experience in Case Management or Utilization Review Business and Financial Knowledge as well as ... each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations… more
- Brockton Hospital (Brockton, MA)
- …Develops, implements and evaluates the strategic plan for the organization-wide Case Management system and process for all services across Signature Healthcare. ... the discharge plan; ensures efficient and effective delivery of patient care services through the appropriate utilization of healthcare resources. Participates… more
- University of Rochester (Rochester, NY)
- …of Medicare and other payer regulations for the coordination of benefits. + Notify Utilization Management of clinical requests by third party payers. + Maintain ... Counseling, Medicaid Enrollment & Outreach, Financial Assistance, Registration and Insurance Management , Utilization Management , Social Work, Patient… more
- Cedars-Sinai (CA)
- **Job Description** The Senior Patient Service Rep is responsible for positive patient relations, accurate telephone communication, appointment scheduling, ... workflows. + As liaison coordinates administrative support activities including facilities management , patient billing, utilization management , quality … more
- Cedars-Sinai (Playa Vista, CA)
- **Job Description** The Lead Patient Service Rep functions as an administrative team lead for the office. This position supports the physician and nursing staff ... to address physician and staff concerns such as facilities management , patient billing, utilization management ,...Five (5) years of experience working as a Patient Service Rep in an outpatient clinical/medical office… more
- University of Rochester (Rochester, NY)
- …documentation required to complete the precertification process AND Communicates with Utilization Management and Financial Counseling throughout the admission to ... IRF-PAI + Maintain and access data to analyze clinical utilization and costs (10%) + Measure and maintain clinical...ensure payment for rehab services (5%) **QUALIFICATIONS** + Associate's degree in business field… more
- Molina Healthcare (New York, NY)
- …example, such meetings would occur to discuss and resolve issues related to utilization management , pharmacy, quality of care, and correct coding. * ... that services Molina members, including but not limited to Fee-For- Service and Pay for Performance Providers. It is an external-facing, field-based position… more
- Hackensack Meridian Health (Red Bank, NJ)
- …of Case Management ** , is responsible for all activities related to Case Management , Social Work and Utilization Management , including, but not limited ... + Leads the implementation and oversight of the hospital Utilization Management Plan using data to drive...policies and procedures and process improvements. + Serves as representative and resource for community and regional services… more
- Highmark Health (Charleston, WV)
- …drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management , utilization management , immunizations, specialty ... Delivery + Managed Care + Healthcare + Care Planning + Continuous Improvement + Utilization Management + Healthcare Management + Utilization Review… more
- VNS Health (Manhattan, NY)
- …leadership to develop and implement plans to meet needs. + Provides guidance and consultative services to Utilization Management (UM) and Care Management ... medical cases. Participates in the QARR/HEDIS Quality Improvement Activities and utilization management of the population. Works under limited direction.… more
- Ochsner Health (Lafayette, LA)
- …Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management ... experience in the delivery of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either in the Acute Care… more