- Hartford HealthCare (Wethersfield, CT)
- …Resource Management Nurse with support for denials, appeals, and physician advisor communication. 5. Retrieves, manages and/or triages department phone ... Resource Management Associate's focus is on providing support and coordination of utilization management services for the utilization management … more
- The Hartford (Hartford, CT)
- …necessity and appropriateness using nursing judgment, treatment criteria guidelines and Physician Advisor /Peer Clinical Review referral process. Conduct first ... to regulatory and ethics requirements. + Comply with URAC Workers' Compensation Utilization Management Standards and Policy and Procedures. + Comply with… more
- Cardinal Health (Hartford, CT)
- …the future. The Director, Managed Care is responsible for strategy and management of managed care contracts and relationships with payers. They are responsible ... is to work diligently to ensure optimal reimbursement for physician services and physician satisfaction as it...Care environment. They will be a seasoned leader and advisor , with proven experience supporting physicians in oncology to… more
- The Cigna Group (Bloomfield, CT)
- Delivers specific delegated tasks assigned by a supervisor in Utilization Management . Handles moderately complex medical review, utilization review, ... appropriate course of action for treatment. May analyze treatment patterns and utilization trends. Contributes to the development and implementation of action plans… more
- Fresenius Medical Center (Springfield, MA)
- …departments and external customers; particularly in problem resolution. Acts as an advisor to subordinate(s) to meet schedules and/or resolve technical problems. + ... and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely… more