- 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 ... areas.Meet with Sales Leadership on a regular basis to review processes and gain insight of the field needs...and field delivery on these tactics, ultimately creating increased utilization of the DSI portfolio in appropriate patients.Build strong… more
- Novo Nordisk Inc. (Pearland, 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
- State of Connecticut, Department of Administrative Services (Hartford, CT)
- Utilization Review Nurse (40 Hour) Office/On-site Recruitment # 250102-5612FP-001 Location Hartford, CT Date Opened 1/6/2025 12:00:00 AM Salary $78,480 - ... and Addiction Services ( DMHAS (https://portal.ct.gov/DMHAS/About-DMHAS/Agency/About-DMHAS) ) as a Utilization Review Nurse (https://www.jobapscloud.com/CT/specs/classspecdisplay.asp?ClassNumber=5612FP&R1=&R3=) ! Bring your… 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
- Hartford HealthCare (Mansfield Center, CT)
- …empowering individuals to participate in their own care and recovery. _*Job Summary*_ Utilization Review Care Manager coordinates the care of clients in ... your moment.* **Job:** **Behavioral Health* **Organization:** **Natchaug Hospital* **Title:** * Utilization Review Care Manager - Behavioral Health* **Location:**… 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
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator I Job Details Job Location Bellevue - Bellevue, WA Position Type Full Time Salary Range $66,122.00 - $95,904.00 Salary Description and ... Qualifications The Organ Utilization Coordinator (OUC) is accountable for all activities related to the allocation and utilization of organs from donors. This… more
- CVS Health (Columbus, OH)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... residence. Shift times may vary occasionally per the need of the department.** **No travel is required.** As a Utilization Management Nurse Consultant, you will… 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 (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
- Humana (Columbus, OH)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization … 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
- CVS Health (Lansing, MI)
- …**Position Summary:** The Associate Manager is responsible for oversight of Utilization Management/Case Management staff. This position is responsible for the ... Managers, Manager, and other key stakeholders such as program design/product, Medical Directors, account teams/plan sponsor liaisons, etc.) to ensure consistency in… 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
- Molina Healthcare (Warren, MI)
- …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 (Kenosha, WI)
- …seeking a (RN) Registered Nurse with previous experience in Hospital Acute Care, Concurrent Review / Utilization Review / Utilization Management and ... 30 days of employment._** **_Ability/knowledge to cross train, inpatient medical to inpatient BH or inpatient Medical ...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… more
- Point32Health (MA)
- …work closely with staff from all partners of UM ( Utilization Management), Medical Management Departments on these review activities. They will also work ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Medical Director, Clinical reviews will primarily perform utilization … 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
- Spokane County (Spokane, WA)
- …Organization Integrated Care and the Behavioral Health Administrative Services Organization Utilization Review Integrated Care. TOTAL COMPENSATION: $85,812 - ... and discharges or lack of movement toward discharge. + Collaborates with Utilization Review Integrated Care Coordinator regarding continued inpatient stay… more
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