- 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
- Katmai (Fort Carson, CO)
- …access to care standards for appropriate utilization of services. Perform utilization management/ review for medical necessity for specialty referrals and ... **SUMMARY** Provide a comprehensive utilization review (UR) and utilization management (UM) program for all TRICARE eligible beneficiaries within the CMHS.… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …on medical necessity and contract language for health plan members, including review of clinical documentation using medical policy criteria, guidelines, ... experienced **MD** to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** ....review criteria as a member of the Premera Medical Policy Committee. + Leverage clinical knowledge… more
- Commonwealth Care Alliance (Boston, MA)
- …day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a ... does not have direct reports. **Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …Medical Policy Implementation Workgroup to ensure cross-functional collaboration between Clinical Review , Healthcare Services, and other departments on coding ... Policy Coding Administrator_** is a senior member of the Medical Policy and Clinical Coding team whose...and recommend action steps regarding code configuration issues, annual utilization and review analysis. + Maintain current… 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 ... kidney disease. Training and advancement: You will enter our Clinical Leadership Program that creates and supports a culture...a tremendous asset that sets us apart. At Fresenius Medical Care, you will truly make a difference in… more
- HCA Healthcare - Chief Medical Officer (San Antonio, TX)
- …ongoing in-service programs to facility medical staff regarding clinical resource management, appropriate documents standards, utilization and quality ... of quality and cost improvement and develops systems to review utilization of resources and objectively measure... staff affairs. Serves as a consultant to hospital Medical Staff Services regarding physician credentialing, utilization ,… more
- Stony Brook University (Stony Brook, NY)
- Clinical Lab Technologist II -Blood Gas Technician **Position Summary** At Stony Brook Medicine Respiratory Care Department, a **TH Clinical Laboratory ... while adhering to our high standard of excellence. **Duties of a TH Clinical Laboratory Technologist in the Respiratory Care Department may include the following but… more
- Monte Nido (White Plains, NY)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... clients participate in group and individual therapy, benefit from Monte Nido's clinical , medical , psychiatric and nutritional expertise and experience real life… more
- Buckeye Community Health Plan (Thornville, OH)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , ... 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
- Battelle Memorial Institute (Sneads Ferry, NC)
- …in a patient registry + Maintain accurate and current notes in the electronic medical records of all patients contacted for review by the managing physician ... and Analytics (HRA) business line is seeking a highly motivated, full-time **Licensed Clinical Social Worker (LCSW)** to join our team in support of our government… more
- Oregon State University (Portland, OR)
- …Department Pharmacy Professnl Instr (PHR) Position Title Assistant/Associate Professor ( Clinical ) Job Title Assistant/Associate Professor ( Clinical ) Appointment ... a full-time (1.00 FTE ), 12-month, fixed-term, Assistant or Associate Professor ( Clinical ) position. Reappointment is at the discretion of the Department Head.… more
- BeOne Medicines (San Mateo, CA)
- …and execution of the Clinical Study Report in collaboration with Global Clinical Study Manager and Medical Writing **Quality:** + Handles escalated issues or ... readiness quality, within agreed timelines and budget + Leads the regional clinical operations team (including oversight of external partners working on the regional… more
- CSL Behring (Waltham, MA)
- …therapies that make a meaningful difference worldwide. Could you be our next AD of Clinical Assay? The job is in our Waltham MA office. This is a hybrid position ... a week. You will report to the Director of Clinical Assay. You will be part of a specialized...robust insourcing outsourcing strategy, ensuring strategic decisions and effective utilization of available resources. Support the selection of vendors… more
- Monte Nido (Clifton, VA)
- …may substitute leadership experience elsewhere. + Working knowledge of admissions and intake, Utilization Review , and 3rd party or insurance payers. + Previous ... providing the opportunity for people to realize their healthy selves. ** Clinical Director** **Clementine Twin Lakes** **Clifton, VA** **Clementine Twin Lakes,**… more
- Novo Nordisk Inc. (Los Angeles, CA)
- About the Department The Clinical , Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... stages of development. Incumbents have a deep scientific and clinical education and experience. Within Field Medical ...c) develops appropriate use of NNI products and greater utilization of its services d) supports and assists representatives… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …serve through our Healthsource blog: https://healthsource.premera.com/ . The **Senior Clinical Pharmacist,** **Oncology Program** will lead and help develop ... of a core team. You'll collaborate cross-functionally with care management, utilization management, provider/member relations, and market-facing teams to enhance the… more
- Monogram Health (Fort Myers, FL)
- …Medicaid populations Experience with NCQA, HEDIS, Medicaid, Medicare, quality improvement, medical utilization management, and risk adjustment Current state ... to dialysis, pre-emptive kidney transplant, conservative management. The Regional Medical Executive is a key clinical leader...data tools to report, monitor, and improve quality and utilization Assist Practice Medical Executives to conduct… more
- Stanford Health Care (Palo Alto, CA)
- …responsibilities include coordinating all facets of a patient's admission/discharge; performing utilization review activities, including review of patient ... other interdisciplinary team members; arranges followup care as appropriate. + Utilization Review -- Reviews prospectively, concurrently and retrospectively all… more
- BoldAge PACE (Oceanport, NJ)
- …needs and desires. Regional Medical Director JOB SUMMARY: The Regional Medical Director (RMD) provides strategic clinical leadership and oversight for ... state regulations require active patient practice. In addition to maintaining a clinical panel, the Regional Medical Director provides administrative leadership… more
