- Randstad US (Boston, MA)
- clinical support specialist - utilization mngmt. + boston , massachusetts (remote) + posted 10 days ago **job details** summary + $23 - $25 per hour + temp ... degree required. + Health care delivery, medical billing, coding and/or customer service experience. + Knowledge of utilization management process (ie, Health… more
- CareFirst (Baltimore, MD)
- …work production quantity and quality. Functional areas may include but not limited to clinical support , operations and services related to health care ... community resource partners, and internal clinical and non- clinical colleagues to ensure effective service delivery...Abilities (KSAs)** + Knowledge and experience in care coordination, clinical support , utilization view and/or… more
- Robert Half Office Team (Bakersfield, CA)
- …As a Clinical Administrator Coordinator, you will be responsible for providing non- clinical support to the utilization management team in maintaining and ... managing the utilization processes for pre- service authorization requests in a timely and accurate manner...offers a long-term contract employment opportunity. Responsibilities: □ Provides non- clinical support to the CDU nurse in… more
- Medtronic (Orlando, FL)
- …**CUSTOMER SUPPORT ** * Acts as the primary Medtronic customer liaison for clinical case support and utilization . * Provides timely information to ... more connected, compassionate world. **A Day in the Life** Support and grow Mazor Robotics Utilization in...trainer). * Continually trains members of the Surgical Synergy Clinical Support team to increase their knowledge… more
- UPMC (Kane, PA)
- …staff development, orientation of new staff, special projects and community programs. + Utilization of clinical support staff (training, supervision and ... Join our dynamic team at UPMC Kane as a Clinical Exercise Physiologist, where every day is an opportunity...Be part of a collaborative environment where your contributions support staff development, special projects, and community programs, making… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Clinical Quality Nurse Reviewer RN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, ... net required to achieve that purpose. Job Summary The Utilization Management Clinical Quality Nurse Reviewer RN...Assurance (NCQA) audit and/or Centers for Medicare and Medicaid Services (CMS) audit. Background in teaching and/or clinical… more
- Hartford HealthCare (Wethersfield, CT)
- …Management team. The Clinical Resource Management Associate's focus is on providing support and coordination of utilization management services for the ... queues. 3. Updates EPIC with authorization and denial information. 4. Provides the Clinical Resource Management Nurse with support for denials, appeals, and… more
- Kepro (AR)
- …Acentra Health! Acentra Health exists to empower better health outcomes through technology, services , and clinical expertise. Our mission is to innovate health ... to join our growing team. Summary Description The Dental Clinical Specialist is responsible for the Utilization ...reviews leverage patient care and treatment planning experience to support the healthcare business process services team.… more
- Kepro (CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary ... Health exists to empower better health outcomes through technology, services , and clinical expertise. Our mission is...As a Utilization Clinical Reviewer, you'll harness your expertise… more
- Kepro (Minneapolis, MN)
- …Acentra Health! Acentra Health exists to empower better health outcomes through technology, services , and clinical expertise. Our mission is to innovate health ... in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer...as providers' liaison and contact/resource person for provider customer service issues and problem resolution. + Performs all applicable… more
- Molina Healthcare (NV)
- …based on the severity of illness and the site of service . **KNOWLEDGE/SKILLS/ABILITIES** The Manager, Healthcare Services provides operational management ... will need to be licensed for Nevada and must support Nevada (Pacific) business hours. Nevada is not a...including plan utilization , staff productivity, cost effective utilization of services , management of targeted member… more
- Point32Health (Canton, MA)
- …Directors, enterprise and division based Behavioral Health leaders to support appropriate utilization of health care services and quality of care for all ... enjoy the important work we do every day in service to our members, partners, colleagues and communities. To... Services to internal and external clients regarding clinical operations, utilization management, complex or unique… more
- Stanford Health Care (Palo Alto, CA)
- …patient care. Working in collaboration with Physician Advisors, Financial Services , Compliance, Denials Management, Patient Access, Clinical Documentation ... interventions. + Generate reports and provide data analysis on utilization metrics, outcomes, and trends to support ...+ Review medical records to ensure complete and accurate clinical documentation to support medical necessity. +… more
- CareFirst (Baltimore, MD)
- …and approved claims. + Oversees retrospective reviews, case appeals, billing coordination, and clinical support . + Ensure that staff is fully trained and ... strategy. Plans, directs and evaluates the full scope of utilization management services offered and works closely...order to control and appropriately allocate resources. + Monitors utilization patterns, such as demographics of service ,… more
- The Cigna Group (Franklin, TN)
- …outcomes monitors focusing on potential over- and under- utilization of delegated services + Oversee clinical policy development via the Medical Advisory ... The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to...UM programs or services , supported by program clinical leaders + Provide SME support to… more
- Lucile Packard Children's Hospital Stanford (Palo Alto, CA)
- …for timeliness of services as well as appropriate utilization of services ; and ensuring optimum use of resources, service delivery, and compliance with ... services /procedures. Communicates with review organizations/payers to provide requested clinical and psychosocial information to assure reimbursement. UTILIZATION… more
- CVS Health (Columbus, OH)
- …all encompassing): - Reviews services to assure medical necessity, applies clinical expertise to assure appropriate benefit utilization , facilitates safe and ... the following schedule:** **Monday-Friday 8:00am-4:30pm EST.** **Position Summary** As a Utilization Management Nurse Consultant, you will utilize clinical … more
- ERP International (Corpus Christi, TX)
- …assessment, planning, implementation, coordination, and monitoring. * Collect and analyze clinical utilization data to identify information on resource ... management of specified patients. Perform a full range of utilization management services including referrals, care coordination,...outcomes of care. * Develop and implement tools to support utilization management, such as those used… more
- The County of Los Angeles (Los Angeles, CA)
- …Education in nearly every medical specialty and subspecialty. In addition to its direct clinical services , DHS also runs the Emergency Medical Services (EMS) ... UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply...Job Type Full time Job Number Y5126D Department HEALTH SERVICES Opening Date 06/08/2020 + Description + Benefits +… more
- LifeCenter Northwest (Bellevue, WA)
- …meetings, Clinical Advisory Subcommittee meetings, and internal and external Organ Utilization and Clinical Services meetings. This includes managing ... Specialists, Surgical First Assists, Organ Utilization Coordinators, and Clinical Communications Coordinators). + Organize and support external transplant… more