- Alameda Health System (Oakland, CA)
- …each individual in the classification. Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. ... utilization reviews and determine program improvements. Develop and implement utilization review policies and procedures in accordance with industry… more
- Buckeye Community Health Plan (Thornville, OH)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends... review studies and evaluates adverse trends in utilization of medical services, unusual provider practice… more
- HCA Healthcare - Chief Medical Officer (San Antonio, TX)
- …a data-driven environment of quality and cost improvement and develops systems to review utilization of resources and objectively measure outcomes of care in ... staff affairs. Serves as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization ,...quality profiling. Serves as a member of hospital's peer review committees as requested. Please click here to view… more
- Vista Community Clinic (Vista, CA)
- …of clinic protocols and procedures to ensure quality medical care Participate in utilization and peer review programs which evaluates the quality of the ... technicians and other staff. Participate in quality assurance, quality improvement and utilization review Provide in-service training to clinic staff to increase… more
- Novo Nordisk Inc. (Minneapolis, MN)
- About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... and developing and implementing regulatory strategies with the FDA to providing medical education and collecting data to support efficacy and new product… more
- Monogram Health (Fort Myers, FL)
- …Medicaid populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment Current state ... Utilize IT and data tools to report, monitor, and improve quality and utilization Assist Practice Medical Executives to conduct retrospective reviews of… more
- BoldAge PACE (Oceanport, NJ)
- …Professional Growth Access to training and career development. Competitive Compensation: Medical /Dental Flex Time Off 401K with Match Life Insurance Tuition ... and their caregivers to truly understand their needs and desires. Regional Medical Director JOB SUMMARY: The Regional Medical Director (RMD) provides… more
- Trinity Health (Syracuse, NY)
- …with the administrative team to oversee department activities. Manage cost management, utilization review , quality assurance, and medical protocol ... St. Josephs Health is seeking a fellowship-trained, board-certified Medical Director of OB/GYN for a 0.1 FTE (4 hours per week) position. This is a unique and… more
- Catholic Health System (Buffalo, NY)
- …better outcomes. 11. Holistic development of patient treatment plans, readily available for review in the EHR. 12. Utilization of appropriate consultation and ... Trinity Medical , WNY, is seeking a dedicated full time...This Physician shall be Board Certified/Eligible in Hematology and Medical Oncology and will provide both inpatient and outpatient… more
- Tris Pharma (Monmouth Junction, NJ)
- …other payer contracts, including redlining contract language, coordinating cross-functional review and approval workflows, and ensuring execution consistent with ... contact for IntegriChain (BPO partner), managing data file submissions, utilization reporting, rebate validation processes, and issue escalation to ensure… more
- Fresenius Medical Care (Atlanta, GA)
- About this role: As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical operations. As ... a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in...activities. Accountable for completion of the Annual Standing Order Review and Internal Classification of Disease (ICD) coding. Manages… more
- Yale New Haven Health (Danbury, CT)
- …A Charge Nurse. Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization , And Staff And Self Development As Outlined In Performance ... Review . Performs Other Duties As Assigned Or Directed To...solid tumor cancers. This specialized department caters to both medical oncology patients, who receive systemic therapies like chemotherapy,… more
- Fresenius Medical Care (Fayetteville, NC)
- …communicated to and implemented by the facility staff. Maintains integrity of medical records and other FMS administrative and operational records. Complies with all ... systems as pertinent. STAFF: Responsible for implementation of FMS staffing, and medical supply models, to provide quality patient care, and makes recommendations.… more
- Yale New Haven Health (Fairfield, CT)
- …A Charge Nurse. Meets Performance Expectations For Customer Service, Teamwork, Resource Utilization , And Staff And Self Development As Outlined In Performance ... Review . Performs Other Duties As Assigned Or Directed To Ensure Smooth Operation Of The Department/Unit. Demonstrates Competency In The Care Of The Neuro Patient… more
- Eisai, Inc (New York, NY)
- At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides to patients, their families, and caregivers is Eisai's human health care ... Executives to work with downstream regional payer accounts of the national payers. Review and analyze applicable data to make informed decisions on regional payer… more
- Luminis Health (Annapolis, MD)
- …coordinate the availability of supplies, instruments, and equipment; ensure appropriate utilization of these resources; and (to the extent possible) standardize use ... trusting and respectful culture, build communication skills, correct educational deficiencies, review errors, and brainstorm solutions for quality team metrics that… more
- Novo Nordisk Inc. (Lubbock, TX)
- …other field-based employees (eg, DBMs, DCSs, Market Access Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The Specialty Field Sales ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- Novo Nordisk Inc. (Irvine, CA)
- …other field-based employees (eg, DBMs, DCSs, Market Access Team, Diabetes Educators, Medical Liaisons) covering the same geographic areas. The Specialty Field Sales ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- Christus Health (Texarkana, TX)
- …department. Participates in medical chart peer review , case record review and utilization review as deemed necessary. Assumes responsibility for ... therapeutic equipment safety, operation and maintenance. Requirements: Education/Skills Basic Computer Knowledge Ability to communicate effectively, both verbally and written. Graduate of an accredited occupational therapy program. Experience New graduate… more
- Unknown (Houston, TX)
- …site. Listen to deliberations and provide verbal feedback as necessary. Visually review all documents pertaining to committee functions. II. Patient Care Provide ... standards set forth by the Texas State Board of Medical Examiners, and the American College of Physicians, properly...with the same level of training and experience. Visually review for proper ICD-9, ICD-10, and CPT coding and… more
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