- Humana (Providence, RI)
- …of our caring community and help us put health first** The Staff Utilization Management Pharmacist is a clinical expert responsible for conducting ... holiday per calendar year** **Job Description:** The Staff Utilization Management Pharmacist is a clinical professional responsible for conducting… more
- Edwards Lifesciences (Providence, RI)
- …post-case management , 3 Mensio management , Therapy Awareness program management and clinical education programs. + Implementing sales and educational ... and implementing growth strategies within focused accounts in partnership with Sales Management . + Developing clinical champions among current and potential… more
- Evolent (Providence, RI)
- … Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making criteria sets. Acts as a member advocate by ... quality and cost effective care delivery. **What You'll Be Doing:** + Performs utilization review of outpatient procedures and ancillary services. + Fulfills on call… more
- US Tech Solutions (RI)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review. + MUST HAVE 1 YEAR OF UTILIZATION ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- Highmark Health (Providence, RI)
- …per week (Tuesday-Thursday).** This role supports the full application product lifecycle for ** clinical and utilization management software** , with a ... and technical teams. They function as a pivotal bridge, translating high-level ** clinical and utilization management software** business needs into… more
- Parexel (Providence, RI)
- …Data Management Lead to join our team. If you have a passion for clinical research, strong project management skills, and a knack for data management , ... Science, OR equivalent industry experience. + 7+ years experience in pharmaceutical/biotech clinical data management / Biometrics ( clinical trial data… more
- Evolent (Providence, RI)
- …Cardiologist)** Are you ready to make a meaningful impact on patient care in a non- clinical setting? Join our Utilization Management team as a Field Medical ... appropriate, high-value care aligned with clinical guidelines. + Collaborate with leadership, management , and clinical staff to address complex cases and… more
- Evolent (Providence, RI)
- …Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …Doing:** As a Field Medical Director, Oncology, you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... better health outcomes. **Collaboration Opportunities:** . Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Evolent (Providence, RI)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... better health outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff , other Physicians, and staff whenever a… more
- Oracle (Providence, RI)
- …user efficiencies, improved care coordination, reduced readmissions, increased access and utilization , and enhanced clinical workflows. * Training & Education: ... achieving health network goals. Key Responsibilities: * Client Consultation & Relationship Management : o Serve as the strategic lead for client engagements, working… more
- Highmark Health (Providence, RI)
- …business relationships, the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The role involves ... executing all facets of the Informatics project management process, leading multiple project managers, and potentially guiding, mentoring, or providing senior-level… more
- Oracle (Providence, RI)
- …+ **Informatics and Strategy** : Work as intermediaries between IT professionals and clinical staff , ensuring that technological changes align with clinical ... providers, nurses, and pharmacists. This role requires a unique blend of clinical expertise, leadership, informatics, change management , and data science skills.… more
- Humana (Providence, RI)
- …care industry, Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience in a medical ... put health first** The Medical Director relies on broad clinical expertise to review Medicare drug appeals (Part D...with prior experience participating in teams focusing on quality management , utilization management , or similar… more
- Fresenius Medical Center (Providence, RI)
- …Radiology Technologists, Front Desk Coordinator. + Ensures adequate staffing through daily management of staff 's schedule, including breaks. + Assess daily ... staff as assigned. + Performs and sets-up in-services regarding equipment, supplies and clinical for all staff . + Coordinates all aspects of patient care with… more
- Baylor Scott & White Health (Providence, RI)
- …the design, execution, and communication of analytical output that identifies cost, utilization , and clinical trends across the organization. This role supports ... support of developing cost mitigation strategies that meet overall clinical and business needs. **_The pay range for this...audiences. + Manages and trains a team of analytics staff ; Responsible for organization, prioritization, and management … more
- Highmark Health (Providence, RI)
- …developing, implementing, supporting, and optimizing the architectural strategy for **all clinical and utilization management applications** . Their ... cloud migration, and AI integration, extending this strategic oversight across **all clinical and utilization management applications** . This involves… more
- Sedgwick (Providence, RI)
- …+ Apply your RN clinical knowledge and experience to provide pharmacy utilization management services to ensure safety, enhance recovery and reduce time out ... examiners regarding pharmacy issues. + Performs prospective and retrospective drug utilization management reviews. + Maintains patient privacy and… more