- University Medical Center of El Paso (El Paso, TX)
- Job Description: Assists in development of services, policies, procedures related to Utilization Management / Utilization Review . Collects and analyzes ... service excellence. Required Skills: Knowledge of managed care, reimbursement and utilization management . Demonstrates ability to analyze related information,… more
- Staffing Now (Norfolk, VA)
- …precertification, prior authorization, and post service requests. Refers cases requiring clinical review to a Nurse reviewer . Responsible for the identification ... openings! Responsible for coordinating cases for precertification and prior authorization review . Primary duties may includes, but are not limited: Managing incoming… more
- Staffing Now (Norfolk, VA)
- …precertification, prior authorization, and post service requests.Refers cases requiring clinical review to a Nurse reviewer .Responsible for the identification ... $17/hour Responsible for coordinating cases for precertification and prior authorization review . Primary duties may includes, but are not limited:Managing incoming… more
- Cambia Health Solutions, Inc (Portland, OR)
- …a member of the Behavioral Health team, our Clinicians provide utilization management (such as prospective concurrent and retrospective review ) to best meet ... Behavioral Health Utilization Management Clinician Work from home...prospective, concurrent, and retrospective assessments, to ensure adherence to medical necessity and policy standards.Applies clinical expertise and evidence-based… more
- GHR Healthcare (Atlanta, GA)
- …Pay Rate: 37.50 -40.00 Hourly (paid weekly) What You'll Do: Clinical Analysis: Review medical records to determine the necessity of patient services based ... a detail-oriented RN with a knack for navigating complex medical cases? Do you thrive on making critical decisions...that impact patient care? Join us as a Care Management Coordinator and play a key role in evaluating… more
- Equiliem (Orange, CA)
- …the Medical Director's decision and documents follow-ups in the utilization management system. Completes required documentation for data entry into ... the Medical Director's decision and documents follow-ups in the utilization management system. Completes required documentation for data entry into… more
- Novo Nordisk Inc. (Philadelphia, PA)
- 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
- 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 ... including handling internal audit. Work closely with IT regarding implementation and utilization of new software tools developed by the DS organization and/ or… more
- US Tech Solutions, Inc. (Columbia, SC)
- …Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... . May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews and makes a… more
- RIVET OPERATIONS COMPANY LLC (San Diego, CA)
- …, monitor and analyze data received from ashore aviation units.Initiate and review configuration management and outfitting directives, develop AVCAL and SHORCAL ... and a leader in physical and cyber security, IT management , logistics, supply chain management , process improvement...product listings, and review IMRL listing for accuracy. Review , analyze, and… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …of individual patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to ... assure patient management that efficiently and effectively aligns with patient needs...to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent… more
- Lennar Homes (Irving, TX)
- …the adoption of quality platforms, and leading engagements with leadership to review and enhance quality KPIs. Additionally, this role will introduce Data Quality ... dreams come true.A career built on building zero defect homes, cost management , and adherence to schedules. Your Responsibilities on the Team Design, implement,… more
- zobility (Indianapolis, IN)
- …requirements necessary to maintain configuration control and meet quality management system standards, promotes efficient, collaborative, and timely CM workflow, ... coordinates document and data deliverable management , identifies and troubleshoots anomalies, demonstrates and promotes analytical thinking, and capably communicates… more
- Northeast Georgia Health System, Inc (Oakwood, GA)
- …to ensure appropriate feedback is received before product decisions are made. Utilization Review of necessity, quality, effectiveness and efficiency of ... of system-wide opportunities as they relate to Value Analysis standardization, utilization and implementation. Facilitate Value Analysis Teams (VAT) to most… more
- Pacer Staffing (Atlanta, GA)
- … Utilization Review Certification or Certified Professional Utilization Management Certification Experience in UM policy writing, development, ... Job Description: Summary: This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and… more
- Pacer Staffing (Atlanta, GA)
- …description Job Summary This individual contributor position reports to the Directors of Utilization Management (UM) and Referral Management (RM) and ... Nurse, with current unrestricted license in appropriate state . 4+ years Utilization Management experience . Proficient at in-depth analysis of clinical… more
- Sonora Quest (Sterling, CO)
- …the appropriate use of supplies and materials and assists with inventory management . Ensures efficient utilization of reagents and supplies. Recognizes and ... based on education & experienceIn accordance with State Pay Transparency Rules.Calling all Medical Lab Technicians! Come do great work on behalf of better health in… more
- Russell Tobin & Associates (Remote, OR)
- …4 Month Contract You will be responsible for providing non-clinical support to the utilization management team in maintaining and managing the utilization ... manner consistent with policies and procedures as described in the Utilization Management plan. Responsibilities: Consistently exhibits behavior and… more
- Blanchard Valley Health System (Findlay, OH)
- …the Acute Care Transitions Team, including the disciplines of Social Work, Case Management , Utilization Review , and Emergency Department Care Navigation to ... of appropriate services during acute care stay. Duty 9: Maintains position as Utilization Review committee chair. Works in collaboration with ambulatory care… more
- Merck & Co. (North Wales, PA)
- …innovative individuals dedicated to advancing our company's contribution to global medical innovation by leveraging information and technology.-One of the key ... our Company is a significant focus-on Data and its utilization as a Strategic asset to drive insights-driven decisions....not limited to Data Marketplace, Data Quality, Data Risk Management c) Value Realization with use of these Data… more
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