- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... RBQM Center of Excellence for central statistical monitoring topics, ensure optimal utilization of the cross functional SMEs to embed RBQM across portfolio of… more
- Daiichi Sankyo, Inc. (Bernards, NJ)
- …pharmaceutical therapies to improve standards of care and address diversified, unmet medical needs of people globally by leveraging our world-class science and ... cross-functional, integrated study plan and create initial study budget. Review study feasibility assessments provided by the CRO(s), lead...risk related plans and ensure study team adherence and utilization . Be aware of and be able to predict… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …Tool (RACT) Ensure country and site selection meet study requirements. May review critical study documents, such as consent forms, study manuals, subject recruitment ... CRO or internally) to ensure robust oversight for study level data review , including trend evaluation and full risk assessment. Provide input in internal/external… more
- Novo Nordisk Inc. (Mckinney, TX)
- …proactive collaboration with internal teams such as Sales, Marketing, Market Access, Medical , Legal, and Compliance, contributing to NNI's CM Sales organization and ... and adapting to business priorities Educate HCPs to increase product utilization , optimize treatment, and align with evidence-based medicine and guidelines, while… more
- BAXTER (Batesville, IN)
- …and in the home. For over 85 years, we have pioneered significant medical innovations that transform healthcare.Together, we create a place where we are happy, ... parts or products and to achieve maximum efficiency and utilization .Read and interpret blueprints, technical drawings, schematics, or computer-generated… more
- Intermountain Health (Murray, UT)
- …+ Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and Analysis:** ... will apply expertise in Applied Behavior Analysis (ABA) to review medical records and treatment plans for...in behavioral health. + Knowledge of healthcare insurance and utilization review processes. + Excellent communication and… more
- Health Advocates Network (Medford, OR)
- Health Advocates Network is urgently hiring Discharge Planning and Utilization Review Registered Nurses (RNs) in the Medford, OR area. Must have 2 years of ... Discharge Planning and Utilization Review experience. * Pay Rate: $2,608...opportunities. Benefits We Offer: Competitive pay rates, Referral Bonus, Medical , Dental, Vision and 401k. Travel reimbursement… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... Utilizes available resources to promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …optimize member care and ensure a constructive provider experience + Facilitate review process by communication with members/families, providers, medical staff ... BCBSMA utilization management process + Collaborate with members/families, providers, medical staff and/or other members of the treatment team to coordinate and… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...**Location:** Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN… more
- McLaren Health Care (Port Huron, MI)
- … records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience * Three years of recent ... determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization … more
- McLaren Health Care (Detroit, MI)
- … records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + Three years of recent ... determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization … more
- Ochsner Health (Jefferson, LA)
- …relationships, contract management, standardization and consolidation processes and utilization analysis. Reviews, analyzes, negotiates, and develops contractual ... product change and serves as an internal advocate of product standardization/ utilization initiatives; coordinates new product introduction and overall product change… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- FlexStaff (Uniondale, NY)
- …Works closely with the Physician and/or Medical Director to ensure that medical review of specific cases occurs timely and meets standards for decision ... medical necessity criteria. The Senior Director of Clinical Review will monitor the Clinical Review Nurse's...4. Two to three (2 - 3) years of Utilization Review experience at a Managed Care… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care. + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs. + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more
- Actalent (Uniondale, NY)
- …Work closely with the Physician and/or Medical Director to ensure timely medical review and adherence to decision turnaround standards. + Identify and refer ... file. + Present cases to the site Physician and/or Medical Director for review and determination. +...+ Two to three (2 - 3) years of Utilization Review experience at a Managed Care… more
- Molina Healthcare (Columbus, OH)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… more
- Molina Healthcare (Buffalo, NY)
- …Bachelor's Degree in Nursing **Preferred Experience** Recent hospital experience in ICU, Medical , or ER unit. Previous experience in utilization management, ... a candidate with a RN licensure, UM and Inpatient Review experience. The Care Review Clinician must...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- … review processes with other departments to prevent inappropriate utilization of resources 11. Form recommendations regarding process improvements to eliminate ... our FLEX persona. The position serves as a Prepayment Review Coding Specialist within the Fraud Investigation & Prevention...The position will be a dedicated coding specialist reviewing medical records to identify instances of health care fraud,… more
