- 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
- UnitedHealth Group (Dallas, TX)
- …Cardiology, Endocrinology, radiation oncology (other specialties will be considered) Experience in utilization and clinical coverage review Reside in Nebraska or ... experience, and manage health care costs. The Medical Director provides physician support to Enterprise Clinical Services operations, the organization responsible… more
- Sutter Health (Oakland, CA)
- …and case management within a managed care environment. Comprehensive knowledge of Utilization Review , levels of care, and observation status. Some awareness ... health care services. The PA will develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical… more
- Ascension Health (Austin, TX)
- …the time of the offer. Responsibilities Coordinate the daily operations of a physician practice or health center. Serve as a liaison between practice physicians and ... place to meet the demands of the provider's work schedules. Coordinate utilization of float pool associates and maintain associate payroll information. Complete and… more
- Mount Sinai Health System (New York, NY)
- …Experience Requirements Previous experience as in homecare, long term care or utilization review preferred. Discharge Planner or Case Manager preferred. Manager ... are not limited to: a. Reviews all new admissions to identify patients where utilization review , discharge planning, and/or case management will be needed using… more
- Bon Secours Mercy Health (Toledo, OH)
- … executive leadership and support to medical staff includes oversight of physician utilization , compliance, leadership development, and physician relations. ... visits annually) and full-service imaging center. The VPMA serves as senior hospital physician and as a member of senior leadership team. Provides leadership and… more
- Evolent (Carson City, NV)
- … utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality ... for the culture. What You'll Be Doing: As a Physician Clinical Reviewer, Interventional Pain Management, you will be...Management, you will be a key member of the utilization management team. We can offer you a meaningful… more
- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... of the manager of in-patient care management and the Director of Utilization Management. Required Qualifications 3 Years Experience in the acute patient care… more
- Kaiser Permanente (San Francisco, CA)
- …environment. Preferred Qualifications: Minimum two (2) years of experience in utilization review , case management, and discharge planning preferred. Bachelors ... for alternative levels of care as required. Essential Responsibilities Utilization Management: Performs daily pre-admission, admission, and concurrent utilization… more
- AdventHealth West FL Division (Tampa, FL)
- …as physician advisor to the Case Management staff and serves as physician liaison to promote appropriate utilization of resources by the medical staff. ... protocols that come with evidence based model approach. Provides counsel and physician perspective at senior leadership discussions and action plans related to… more
- OhioHealth (Columbus, OH)
- …verification. When necessary, obtains pre-authorization from insurance companies. Interacts with physician offices and other third parties to obtain all necessary ... and coordination of services through proactive collaboration and communications with utilization management and care coordination team. 5. Monitor commercial payers… more
- Humana (Austin, TX)
- …Systems, health insurance, other healthcare providers, clinical group practice management. Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, review of all… more
- Highmark Health (Salt Lake City, UT)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... units that may assist in the resolution of issues or problems. Access, review , utilize, contribute content to and participate in the maintenance of the shared… more
- Houston Methodist (Sugar Land, TX)
- …and/or coordinating complex delivery of care within a large, multi- physician primary care, specialty, or multi-disciplinary practice. This position supervises ... competent and engaged employee group by conducting regular department meetings to review policies and procedures and operational matters, rounding on all employees,… more
- MD Anderson Cancer Center (Houston, TX)
- …site. Listen to deliberations and provide verbal feedback as necessary. Visually review all documents pertaining to committee functions. *II. Patient Care * Provide ... Anderson at community events, educational forums, and among referring physician groups across the region. Practice clinical medicine in...the same level of training and experience. b. Visually review for proper ICD-9, ICD-10, and CPT coding and… more
- UCLA Health (Los Angeles, CA)
- …and external, to assist patients with discharge/post hospital care Interact closely with Utilization Review and Patient Business Services to ensure correct and ... Working knowledge in the functional operations of third party payors and utilization review agencies to expeditiously coordinate follow-up Working knowledge of… more
- Novo Nordisk Inc. (Lubbock, TX)
- …and unique insights Leverages superior understanding of complexities within the targeted physician customer base in order to maximize performance Applies high level ... appropriate patients that would benefit in order to ensure early trial and utilization Generates advocacy for Novo Nordisk products and services by sharing approved… more
- BJC HealthCare (St. Louis, MO)
- …St. Louis Children's Hospital One Children's Place St. Louis, MO 63110 Supervises the Utilization Review and Navigator teams Excellent team culture! This is an ... RN experience At least 2 years of leadership experience Utilization Review experience RN Case Coordination experience...25 of all 10 specialties. The hospital's academic and physician partner, Washington University School of Medicine, is one… more
- Christus Health (Texarkana, TX)
- …therapy department. Participates in medical chart peer review , case record review and utilization review as deemed necessary. Assumes responsibility ... sets goals, plans programs and treats patients according to the physician 's orders; maintains required records and notes; assists with directing technicians… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , and scheduling requirements.Able to operate and maintain department ... patient's problem and routes to physicians.Returns phone calls according to physician instruction. May schedule patient appointments.In partnership with physician… more
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