- Commonwealth Care Alliance (Boston, MA)
- …procedures, Medicare Part B medications, Long Term Services and Supports (LTSS),DME and Home Health (HH) + Applies established criteria (eg, InterQual and other ... review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring...(nice to have):** + 2 or more years of Home Health Care experience + 2 or… more
- Premera Blue Cross (Mountlake Terrace, WA)
- …as well as the review and adoption of health plan developed review criteria. This is a work-from- home opportunity! This role is PT (typically 20 hours ... to join our team as an **Assistant Medical Director ( Utilization Management - Oncology)** . The AMD will leverage...determinations based on medical necessity and contract language for health plan members, including review of clinical… more
- Stanford Health Care (Palo Alto, CA)
- …if appropriate. + High Risk Member Complex Case Management: + Proactively review Health Risk Assessments and at-risk patient populations for identification ... coordination services for complex patients as needed, including scheduling appointments, home health , DME, transportation, financial assistance, and linkages… more
- University Health (Pleasanton, CA)
- …recent, full-time hospital experience preferred. Work experience in case management, utilization review or hospital quality assurance experience is preferred. ... POSITION SUMMARY/RESPONSIBILITIES At the front door of University Health , this role serves to screen patients needing...status determinations, and the coordination of appropriate diversions to home or other level of care more appropriate for… more
- Stanford Health Care (Palo Alto, CA)
- …Day - 08 Hour (United States of America) **This is a Stanford Health Care job.** **A Brief Overview** The Oncology Research Nursing Professional (ORNP) -is ... research patient care across the continuum of care (outpatient, inpatient and home ) including triage of phone calls and proactive patient communication. The Oncology… more
- BroadPath Healthcare Solutions (Tucson, AZ)
- …+ High school diploma or equivalent + 4+ years of foundational Utilization Management experience + General understanding of health plan operations, ... excited to announce that we are hiring **Work from Home Appeals and Grievance Specialists** . The Appeals and...UM Prior Authorizations, Appeals, Fair Hearings and External Medical Review + Community Health Worker (CHW) certification,… more
- Commonwealth Care Alliance (Boston, MA)
- … and Clinical teams to support consistency and quality across BH and Health Home providers. - Participate in case review meetings and rounds as needed to ... outcomes, and strengthen community-based partnerships. This position works closely with CCA's Behavioral Health , Health Home , Network, and Clinical teams to… more
- Stanford Health Care (Menlo Park, CA)
- …to be discovered. Day - 08 Hour (United States of America) **This is a Stanford Health Care job.** Located in the heart of Silicon Valley, Stanford Health Care's ... time. The Facilities Services division plays a key role in helping Stanford Health Care accomplish this mission. With a fast-paced, tech-savvy and lean culture that… more
- ERP International (Luke AFB, AZ)
- …Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); CAMH; (AAAHC); Health Services ... opportunity. www.erpinternational.com **Be the Best!** Join our team of exceptional health care professionals across the nation. Come discover the immense pride… more
- GCI Communication Corp (Anchorage, AK)
- …and utilization to meet business and operational needs. + Facilities Utilization & Performance: Regularly review network facilities utilization and ... Ability to work shifts as assigned, work in standard office/ home office setting, and operate standard office equipment. +...to Alaskans and may need to respond to public health and safety matters or other business emergencies. Due… more
- GCI Communication Corp (Anchorage, AK)
- …and utilization to meet business and operational needs. + Facilities Utilization & Performance: Regularly review network facilities utilization and ... Ability to work shifts as assigned, work in standard office/ home office setting, and operate standard office equipment. +...to Alaskans and may need to respond to public health and safety matters or other business emergencies. Due… more
- The Clorox Company (Caguas, PR)
- …the Master Site Plan, making sure it follows the capital projects, space utilization , and future expansion needs. + Define scope, schedule, budget, and resources for ... Prepare and be responsible for the annual and 3-year capital program; review all AFEs (Authorization for Expenditure) for transparency and validated business… more
- Monte Nido (Springfield, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... opportunity for people to realize their healthy selves. **Mental Health Therapist** **(LCSW, LICSW, CSWA, LMFT, LPC, QMHP, or...**$10,000 in relocation assistance** to help you make Oregon home + Full coverage of **Oregon licensing fees** for… more
- ERP International (Camp Pendleton, CA)
- …practice guidelines, regulations, manuals, reports and actively engages patients in their health care. + Review details and expectations regarding referrals with ... **Licensed Vocational / Practical Nurse** for a full-time position supporting the **Branch Health Clinics** at **Camp Pendleton, CA.** **Be the Best!** Join our team… more
- Somatus (Mclean, VA)
- …Product Areas:** Clinical Claim Review , Payment Analytics, Fraud Capture, Utilization Review **Product Management** + **Build** business cases to secure ... more days out of the hospital and healthier at home . It takes a village of passionate and tenacious...align with Somatus' short- and long-term goals, across population health and product innovation. If you thrive on blending… more
- The Clorox Company (Rogers, AR)
- …the function. - Communicate effectively, lead implementation, and analyze and review results. - Develop operations excellence expertise in others Conduct process ... health checks, GEMBA, and learn from previous ways of...Drive focused improvement project tools to eliminate losses. - Review process improvements and provide recommendations for driving results.… more
- ExxonMobil (Spring, TX)
- …. **About Houston** ExxonMobil's state-of-the-art campus north of Houston serves as home to its Upstream, Product Solutions and Low Carbon Solutions businesses and ... provides advice to the Commercial organization on risk appetite, risk limit utilization and market risk mitigation strategies, and risk assessments and insights to… more
- The Clorox Company (Martinsburg, WV)
- …needs. + Document and streamline work processes to support effective adoption and utilization of the MES. + Coach and train site personnel on MES system ... management and change management experience + Ability to train others and review and customize training materials. + Problem-solving mindset: Ability to assess and… more
- BayCare Health System (Clearwater, FL)
- …per week in office Equal Opportunity Employer Veterans/Disabled **Position** Intake Specialist Utilization Review - Health Plan **Location** Clearwater:Park ... of 16 community-based hospitals, a long-term acute care facility, home health services, outpatient centers and thousands...the necessary information is gathered for timely and accurate utilization review and that requests for care… more
- Tenet Healthcare (Detroit, MI)
- RN Utilization Review - Case Management - 2506004107 Description : Join our dedicated healthcare team where compassion meets innovation! As a Registered Nurse ... care and appropriate level of care Mentor and monitor work delegated to Utilization Review LVN/LPN and/or Authorization Coordinator as needed. (5% daily,… more
