- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... these skills assists the Medical Center in providing optimal care in a cost effective manner and promotes the...the efficient and effective use of patient services. The Utilization Review Team's role in data collection,… more
- nTech Solutions, Inc. (Baltimore, MD)
- …assisting with non- clinical administrative tasks and responsibilities related to pre-service, utilization review , care coordination and quality of ... care . The Utilization Management Coordinators will be working in a team...Management Coordinators will receive cases from the Manager of Clinical Support on a daily basis, review … more
- A-Line Staffing Solutions (Harrisburg, PA)
- …. MDS, Clinical experience, hospital, nurse auditor, Utilization review , medical fraud, Research Nurse, Nurse reviewer , Prior Authorization, Medicare, ... A-Line Staffing is now hiring in Hybrid Auditor Review Registered Nurse in Harrisburg, PA 17105. If...Office Suite programs including outlook, word and excel Long-term care experience is preferred Minimum Data Set (MDS) experience… more
- UNC Health (Chapel Hill, NC)
- …efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and ... email, data base tasks, or other electronic communication and via telephone.Responsibilities:1. Clinical Review Process - Uses approved criteria and conducts… more
- Novo Nordisk Inc. (San Antonio, TX)
- …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. (Philadelphia, PA)
- …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
- Marion County (Salem, OR)
- …with entities on the state and local levels, and involves making sound clinical decisions with complex cases.Exceptional Needs Care Coordination Act as a ... staff regarding care recommendations, diversion opportunities, and Long-Term Psychiatric Care needs. With clinical supervisor acting as CMHP delegate,… more
- NorthBay Health (Fairfield, CA)
- …all aspects of Care Management and Population Health which includes: Utilization Management, Utilization Review , Inpatient, Outpatient and Complex Case ... and implements key processes to maximize efficiency of resource utilization . They will assume overall responsibility for coordinating/managing patient centered… more
- Mindlance (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. Or, 4 years' utilization review /case management/ clinical /or combination; 2 of ... Job Title: Managed Care Coordinator Job Location: Columbia, SC Top 3/5...and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative… more
- A-Line Staffing Solutions (San Antonio, TX)
- … Coordinator, Care Coordination, Discharge Planning, Admission Planning, CMS, Utilization Review , Utilization Management, Home Health, Home Healthcare, ... Medical Management, Community Health, Referrals, LVN, Licensed Vocational Nurse, Clinical Care , Clinical Service, Clinical Coordinator, Nurse,… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …timely basis as evidenced by appropriate documentation. Coordinates all patient care and demonstrates consistent clinical competencies. Documents treatment ... society while learning to live within the limits of their capabilities. Provides care /service that meets the developmental needs of patients across the life span as… more
- University of New Mexico - Hospitals (Algodones, NM)
- This is a Utilization Review position. We review all admissions and continued stay to the hospital for Medical necessity and manage the insurance ... patient responses to interventions in collaboration with quality assurance and utilization review , maintaining interdependent follow-up as necessary * VARIANCE… more
- A-Line Staffing Solutions (San Antonio, TX)
- …Work, Social Worker, Medicare, Medicaid, Discharge Planning, Determination Review , Clinical Review , DSNP, Risk Assessment, Utilization Management, ... hours per week Competitive Pay Rate Keywords: Medical Necessity Review , Clinical Review , Denials, Appeals,...Utilization Review , Managed Care , MCO, Health Insurance, Health Plan, Managed Care… more
- A-Line Staffing Solutions (Killeen, TX)
- …Experience in a managed care environment preferred Keywords: Medical Necessity Review , Clinical Review , Denials, Appeals, Grievances, Medicare, Medicaid, ... Worker, Medicare, Medicaid, Discharge Planning, Determination Review , Clinical Review , DSNP, Risk Assessment, Utilization...Review , DSNP, Risk Assessment, Utilization Management, Utilization Review , Managed Care , MCO,… more
- A-Line Staffing Solutions (Mcallen, TX)
- …Work, Social Worker, Medicare, Medicaid, Discharge Planning, Determination Review , Clinical Review , DSNP, Risk Assessment, Utilization Management, ... hours per week Competitive Pay Rate Keywords: Medical Necessity Review , Clinical Review , Denials, Appeals,...Utilization Review , Managed Care , MCO, Health Insurance, Health Plan, Managed Care… more
- University Hospital New Jersey (Newark, NJ)
- …either CCM, ACMA or RN-BC preferred. Recent experience in case management, home health, utilization review , and or unit clinical specialty required. Basic ... coordinate the patient's progress through the system. He/she collaborates with physicians and clinical staff to ensure resource utilization is appropriate to the… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... organization. From health- care -provider interactions and developing and implementing regulatory strategies with...most up-to-date information on the therapeutic area and NNI clinical plans and study results, product support letters, and… more
- Sentara Health (Hampton, VA)
- …CCCTM, CMAC or CMGT-BC, care management, patient outcome, discharge planning, utilization review , integrated care , flexi, hospital, inpatient, discharge ... continuum, primary focus on the patient transition to the appropriate level of care while facilitating clinical appropriateness and LOS. Directly support those… more
- University of New Mexico - Hospitals (Albuquerque, NM)
- …- Coordinates and facilitate communication between Health Information Management, Utilization Review /Case management, Quality Management, physician leadership to ... monitors, promotes and evaluates, in collaboration with the Trauma Medical Director the clinical aspects of the Trauma program to ensure quality trauma patient … more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- … clinical metrics and any risk managements activities related to clinical care and/or overall departmental operations.Responsible for creating a ... physicians. Coordinates communication between unit team members and attending physicians or clinical ancillary staff to ensure appropriateness of care and… more
