- Humana (Providence, RI)
- …part of our caring community and help us put health first** The Manager , Utilization Management Behavioral Health utilizes behavioral health knowledge and skills ... and communication of medical services and/or benefit administration determinations. The Manager , Utilization Management Behavioral Health works within specific… more
- Fallon Health (Worcester, MA)
- …according to department protocol + Collaborates with attending physicians and health care professionals regarding appropriate utilization of medical services + ... + Requests and obtains relevant clinical information from medical care providers as needed for the clinical review...clinical setting required. + 2 years' experience as a Utilization Management nurse in a managed care … more
- South Middlesex Opportunity Council (Worcester, MA)
- …assigned properties as detailed below. Working closely with an assigned Case Manager to ensure that all property, municipal, regulatory and contractual requirements ... Illness, and Short-Term Disability. + Flexible Spending Accounts, Dependent Care Accounts, Employee Assistance Program, Tuition Reimbursement and more. Primary… more
- Cardinal Health (Providence, RI)
- …(TM) Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy ... therapies to patients who need them-faster.** **_Responsibilities_** The Senior Case Manager supports patient access to therapy through patient support services in… more
- GAF (Providence, RI)
- …this roof, we protect what matters most. **Team Summary** The Maintenance Excellence Manager is a key member of the Corporate Reliability & Maintenance team and ... to execute PM and PdM programs developed for asset care programs. This is a remote-based position with travel...to optimize GAF craft labor efficiencies, as well as utilization of outside contractors.. + Supports development of Asset… more
- Novo Nordisk (Worcester, MA)
- …who need them most. At Novo Nordisk, we are the world leader in diabetes care and a major player in defeating other serious chronic conditions such as obesity, ... positioning Novo Nordisk as a leader in the diabetes care market, understanding the local market and customer needs...Internally, the EDCS reports to the Endocrinology District Business Manager of the specific sales territory. The EDCS interacts… more
- Charter Care Health Partners (North Providence, RI)
- …on the unit. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management; Continuum of Care Management, Discharge planning and ... Summary: Under the Direction of the System Manager , the Lead BH Inpatient Social Worker is...of 5 years clinical experience in acute behavioral health. Utilization review and inpatient behavioral health experience… more
- Fallon Health (Worcester, MA)
- …according to department protocol * Collaborates with attending physicians and health care professionals regarding appropriate utilization of medical services * ... * Requests and obtains relevant clinical information from medical care providers as needed for the clinical review...clinical setting required. * 2 years' experience as a Utilization Management/Prior Authorization nurse in a managed care… more
- CenterWell (Providence, RI)
- …primary care policy and procedure, coding and documentation, quality, utilization , customer service standards, team communication as needed. Training could occur ... goals. It's about living life fully. At the Primary Care Organization, a division of Humana, we want to...LCSW and MSW role performance through direct observation, chart review , data review , and provide guidance to… more
- University Medicine (East Providence, RI)
- …providers, both within and external to the practice, with particular attention to transitions of care . + Review test results and tracks outcomes. + Review ... management. Review patient compliance and risk issues. Work with patient/family/ care team to reduce risk. Work one-on-one with patients. + Arrange group… more
- Cardinal Health (Providence, RI)
- …company connecting patients, providers, payers, pharmacists and manufacturers for integrated care coordination and better patient management. Backed by nearly 100 ... + Support/recommend reporting, query and analysis tools ensuring efficient SAP/database utilization + Diagnosis of problems and resolution for SAP systems +… more
- Hartford HealthCare (Danielson, CT)
- …which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending meetings as ... and chemical dependency services. Through our multi-site network of care , we constantly strive to meet its mission in...oversight of daily operations in the absence of Program Manager . Key responsibilities of Lead Behavioral Health Clinician: *… more
- Hartford HealthCare (Mansfield Center, CT)
- …which may include staff scheduling, scheduling clinical activities, program development, utilization review , case load assignment, and attending meetings as ... and chemical dependency services. Through our multi-site network of care , we constantly strive to meet its mission in...oversight of daily operations in the absence of Program Manager . Key responsibilities of Lead Behavioral Health Clinician: *… more
- Prime Therapeutics (Providence, RI)
- …licensed functions (Pharmacy Benefit Management (PBM), Third Party Administrator, Utilization Review Organization, Business, State registrations, etc); compile ... of interest or other cyclical compliance processes, or implementing a regular review cadence for standard operating procedures (SOP) and policies + Research and… more
- CenterWell (Providence, RI)
- …by accessing and understanding formulary restrictions, plan limitations, drug utilization review overrides, requesting and completing prior authorization, ... good practices within the value-based model. + Know and continually review medication brand and generic names, medical terminology, and pharmaceutical calculations.… more
- Sharecare (Providence, RI)
- …goals and objectives of the care enhancement program by providing telephonic care and resource utilization for members in an appropriate, efficient, and ... individual through the lens of their personal health and making high-quality care more accessible and affordable for everyone. To learn more, visit www.sharecare.com… more
- CVS Health (Norton, MA)
- …your understanding of patient safety and error prevention, quality assurance drug utilization review (DUR), pharmacy professional standards such as corresponding ... of continuous improvement, with the goal of changing health care for the better. **Position Summary:** At CVS Health,...+ Any additional tasks as directed by Supervisor or Manager **Preferred Qualifications:** + 1+ years of related work… more
- Humana (Providence, RI)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed ... policies and procedures ensuring best and most appropriate treatment, care or services for members. UM Administration Coordinator 2...in special projects as assigned by your Supervisor or Manager . **Use your skills to make an impact** Additional… more
- CSL Plasma (Johnston, RI)
- …to ensure efficient plasma collections. You will report to the Center Manager . **The Role** + In compliance with Standard Operating Procedures (SOPs), supervise ... and donor flow. Monitor time card reporting procedures, attendance, and utilization of overtime. + Conduct error investigations and develop recommendations for… more