- Hawaii Pacific Health (Honolulu, HI)
- …and training, as well as internal peer equity. **Position** Specialist , Managed Care - Utilization Mgmt **Category** Administrative **Employment Type** ... As the Specialist , you will be responsible for providing comprehensive managed care information related to Hawai'i Pacific Health contracted health plans,… more
- LA Care Health Plan (Los Angeles, CA)
- … Utilization Management/Case Management experience in a hospital or HMO setting. Preferred: Managed Care experience performing UM and CM at a medical group or ... Utilization Management Nurse Specialist LVN II...At least 4 years of experience in a patient care setting and/or combination in utilization management,… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist RN II Job...experience in a hospital or HMO setting . Preferred: Managed Care experience performing UM and CM at ... support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves… more
- LA Care Health Plan (Los Angeles, CA)
- Managed Long Term Services and Supports Nurse Specialist RN II Job Category: Clinical Department: Managed Long Term Services and Supports Location: Los ... Managed Long Term Services and Supports (MLTSS) Nurse Specialist RN II applies advanced clinical judgment and critical...and must adhere to regulatory mandates that apply to Utilization Management (UM) and Care Management (CM).… more
- Hackensack Meridian Health (Hackensack, NJ)
- …& levels of appeal iv. Root cause analysis & trends v. Participation in Managed Care Contracting & distribution of contract terms where appropriate 7. ... **Overview** The Senior Utilization Review Specialist collaborates with the...Management and Organizational Strategy a. Development & implementation of Utilization Management strategies to assure appropriate health care… more
- LifePoint Health (Athens, TN)
- …seeking talent to fill the position of Intake Nurse and Utilization Specialist for ourGeroPsychDepartment.This job is permanent,full-time. Core competencies ... patients from otherfacilities. * Documentspayer interactions on assigned casesregardingauthorizations with managed care review agencies, in the manner required… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- LA Care Health Plan (Los Angeles, CA)
- …internal LA Care departments such as Care Management (CM), Utilization Management (UM), Managed Long Term Services and Support (MLTSS), Social Services, ... Enhanced Care Management Clinical Specialist II Job...care professionals in a hospital, medical group or managed care setting, such as a health… more
- ManpowerGroup (Rancho Cucamonga, CA)
- …GED required **Key Qualifications** + Requires knowledge of ICD-9/10 and CPT codes + Managed Care or physician office a must + Skilled in computer applications, ... **Job Title: Utilization Management Outpatient** **Duration: 6 months** **Location: Rancho...month)** **Pay rate: $23.98/hr.** **We are looking for an Utilization Management Outpatient** **to join one of our Fortune… more
- Organon & Co. (Plymouth Meeting, PA)
- … while meeting the needs of customers. + Understanding of the local managed care and reimbursement environment relevant to various customer segments and ... their current practice structure, business model, and key influencers (ex: Managed Care Organization/payers, Management Service Organizations (MSOs), employers,… more
- Staffing Solutions Organization (Albany, NY)
- Senior Research Specialist - Aging & Long Term Care One Commerce Plaza, Albany, 99 Washington Ave, Albany, New York, United States of America Req #431 Thursday, ... LLC (PCG), is focused on delighting clients with world-class managed staffing and talent consulting services. SSO is committed...clients and the people they serve. **Senior Healthcare Program Specialist - Aging & Long Term Care … more
- RWJBarnabas Health (Elizabeth, NJ)
- …Required: + High School Diploma required and one-year related experience required + Managed Care and Insurance experience required Preferred: + Passport software ... benefit information/eligibility for patients with insurance benefits + Contacts managed care companies to obtain initial authorization/precertification services… more
- Novant Health (Winston Salem, NC)
- …years pharmacy practice experience, required. Two years of applicable pharmacy benefits, managed care , or applicable clinical and business experience; preferred. ... **Overview** **NOVANT CORPORATE PHARMACY** **PHARMACY BENEFITS SPECIALIST ** Novant Health is an integrated system of physician practices, hospitals, outpatient… more
- Henry Ford Health System (Bingham Farms, MI)
- …and knowledge in patient care and applied therapeutics. Postgraduate experience in primary care or managed care is strongly desired. + Prior experience ... quality of care provided by the primary care team. He/she works with utilization management...waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental… more
- Henry Ford Health System (Bingham Farms, MI)
- …and knowledge in patient care and applied therapeutics. Postgraduate experience in primary care or managed care is strongly desired. . Prior experience ... quality of care provided by the primary care team. He/she works with utilization management...waste, and rework in the region, and improve drug utilization . The Pharmacy Specialist will be instrumental… more
- New York State Civil Service (Albany, NY)
- NY HELP No Agency Education Department, State Title Information Technology Specialist 4 (Database), Box PIMS-798/01571 Occupational Category IT Engineering, Sciences ... year of permanent competitive or 55b/c service as an Information Technology Specialist 4 (Databases). Eligible List Appointment: Candidates must be reachable on the… more
- Boehringer Ingelheim (Gadsden, AL)
- …comprehensive discussions on the payer environment, co-pays, and formulary access. Works with Managed Care Area Managers to generate and sustain support for ... additional responsibilities in teaching hospitals, federal and military hospitals, managed health care facilities, group purchasing organizations, integrated… more
- Boehringer Ingelheim (Chattanooga, TN)
- …comprehensive discussions on the payer environment, co-pays, and formulary access. Works with Managed Care Area Managers to generate and sustain support for ... additional responsibilities in teaching hospitals, federal and military hospitals, managed health care facilities, group purchasing organizations, integrated… more
- Hartford HealthCare (Avon, CT)
- …relationships with patients, acting as a mentor. As someone who successfully managed their own recovery, the Recovery Support Specialist provides patients ... recovery programs. We offer a wide range of programs including Acute Care and Evaluation, Residential Addiction Treatment, Individual, Group & Family Therapy,… more
- Houston Methodist (The Woodlands, TX)
- …the designated area(s) of responsibility or populations served. The Pharmacy Clinical Specialist position supports the delivery of pharmacy managed protocols, ... At Houston Methodist, the Pharmacy Clinical Specialist position is responsible for performing advanced clinical pharmacy duties enabling the delivery of optimal… more