- Hartford HealthCare (Mansfield Center, CT)
- …and empowering individuals to participate in their own care and recovery. _*Job Summary*_ Utilization Review Care Manager coordinates the care of ... And this is* your moment.* **Job:** **Behavioral Health* **Organization:** **Natchaug Hospital* **Title:** * Utilization Review Care Manager - Behavioral… more
- Baylor Scott & White Health (Providence, RI)
- …Note: Benefits may vary based on position type and/or level **Job Summary** As a Manager for Utilization Review , you guide and supervise staff. You oversee ... Success Factors** + Demonstrable knowledge in discharge planning, case management, utilization review and different care levels. + Outstanding written and… more
- Highmark Health (Providence, RI)
- …weekdays** This job implements effective utilization management strategies including: review of appropriateness of health care services, application of ... consistent with established industry and corporate standards and are within the care manager 's professional discipline. + Function in accordance with applicable… more
- Highmark Health (Providence, RI)
- …This job implements the effective utilization management strategies including: review of appropriateness of health care services, application of criteria ... consistent with established industry and corporate standards and are within the care manager 's professional discipline. Effectively function in accordance with… more
- Prime Healthcare (Woonsocket, RI)
- …unable to meet the patient's care needs. The ICM is responsible for the utilization review process as it relates to triage and admission to the Behavioral ... members to join its award-winning team! Landmark Medical Center is a 214-bed acute care hospital in Woonsocket, RI. The hospital has been "A"rated for patient safety… more
- Prime Therapeutics (Providence, RI)
- …hoc reports are provided accurately and on time. + Supports the State Drug Utilization Review Boards and Pharmacy and Therapeutics (P&T) Committee. Potential pay ... every decision we make. **Job Posting Title** Pharmacist Account Manager - New York Remote **Job Description** + Leads...may vary by 8% depending on applicant location. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Elevance Health (Smithfield, RI)
- …or regulation, must be in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- Elevance Health (Smithfield, RI)
- …necessity of requests using clinical criteria. + Performs physician-level case review of musculoskeletal utilization requests. + Conducts peer-to-peer ... for autism and depression, and insightful analytics to improve the delivery of care . The **Clinical Ops Associate Medical Director - Ortho** is responsible for… more
- Hartford HealthCare (Dayville, 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
- Elevance Health (Smithfield, RI)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... health medical services, to ensure the appropriate and most cost-effective medical care is received. May be responsible for developing and implementing programs to… more
- Cardinal Health (Providence, RI)
- …and effective coordination of Cardinal Health's pharmacy operations that service acute care hospitals, hospital retail customers, ambulatory care and alternate ... customized pharmacy program solutions that reduce costs and improve patient care quality for hospitals, health systems and other integrated healthcare providers… more
- Sharecare (Providence, RI)
- …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 ... The RN has the responsibility for supporting the goals and objectives of the care enhancement program by ** ** providing high quality telephonic support in an… more
- Prime Therapeutics (Providence, RI)
- …in-depth client data research, which may involve research and drivers of utilization ; understands resources needed and steps/processes on how to complete the ... depth perception and ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Network Management, Consulting Analytics or Operations &… more
- Prime Therapeutics (Providence, RI)
- …develop pricing in response to moderate to complex RFP's + Evaluates the utilization and financial experience of customers and prospects + Performs claims re-pricing ... depth perception and ability to adjust focus **Reporting Structure** + Reports to Manager or Director in the Finance Department Potential pay for this position… more