Health Utilization Management

(USA-NY-Melville) Utilization Management Nurse Consultant RN | 8/20/2020

CVS Health Utilization Management Nurse Consultant RN Job Description Utilizes clinical skills to coordinate, document, and communicate all aspects of the utilization/benefit management program. Requires an RN with unrestricted active license. Fundamental Components Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline …

VP Clinical Performance & Transformation - Telecommute - UnitedHealth Group - Cypress, CA | 8/2/2020

Apply Now Description Enterprise Clinical Services is an interconnected set of clinical capabilities supporting medical and behavioral health utilization management , disease management and care services for UnitedHealth Group. The teams support members and providers along the care continuum to deliver on the Quadruple Aim; better care, lower per capita costs and improved clinical outcomes. ECS will transform health care, through modernized solutions to support high performing systems of care while …

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(USA-UT-Murray) Utilization Management Coordinator- Pended Claims | 11/26/2019

… referral?in_iframe=1&hashed=-435801949” class=”iCIMS_Anchor iCIMS_Action_Button iCIMS_SecondaryButton” title=”Refer this job to a friend” Refer this job to a friend /a I Job Information University of Utah Health Utilization Management Coordinator- Pended Claims in Murray , Utah Overview As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success …

(USA-SD-Sioux Falls) Utilization Management Coordinator | 11/15/2019

Sanford Health Utilization Management Coordinator in Sioux Falls , South Dakota Job Title: Utilization Management Coordinator City: Sioux Falls Department : Utilization Management - Sioux Falls Job Schedule: Full Time Hours Per Shift: 8 hr JOB SUMMARY Monitors the utilization of resources, risk management and quality of care for patients in accordance to established guidelines and criteria for designated setting and status. Collection of clinical information necessary to initiate commercial payor authorization. Obtain …

NantHealth, Inc. (NH) CEO Patrick Soon Shiong on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/11/2019

… platform received full accreditation from URAC which is valid through September 1 2022 the accreditation which recognizes those companies abiding by evidence-based standards and value-based care means Eviti continues to meet URAC health utilization management standards. For an NaviNet payers engagement solution we had an NaviNet Authorization attachment application through implementation of one of the nation’s largest health insurance organizations. This feature ensures providers receive the right supporting …

NantHealth Reports 2019 Third-Quarter Financial Results | 11/7/2019

… now permit their users to view multiple dashboards, which saves time by reducing the need for multiple logins and passwords Received full accreditation from URAC for the Eviti platform. Eviti continues to meet URAC Health Utilization Management standards, valid through September 1, 2022. The designation recognizes those companies abiding by evidence-based standards and value-based care Payer Engagement (NaviNet ® ): Added Navinet’s Authorization Attachment application to the NaviNet implementation for …

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of coverage guidelines …

Case Manager - Roseburg, OR, , USA #jobs #Roseburg pls RT | 10/22/2019

… to create a Person-Centered Service Plan, provide information about eligibility and referrals, resources, services and supports covered under the 1915i State Plan Home and Community Bases Services benefit. Additionally, there will be Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The …

Case Manager - Medford, OR, , USA #jobs #Medford pls RT | 10/22/2019

… to create a Person-Centered Service Plan, provide information about eligibility and referrals, resources, services and supports covered under the 1915i State Plan Home and Community Bases Services benefit. Additionally, there will be Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The …

(USA-LA-Baton Rouge) Behavioral Health Utilization Management Review | 10/9/2019

AmeriHealth Caritas Behavioral Health Utilization Management Review in Baton Rouge , Louisiana Behavioral Health Utilization Management Review Location: Baton Rouge, LA ID : 18034 Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact …

(USA-ND-Fargo) Utilization Management Specialist RN - Patient Access | 9/13/2019

Sanford Health Utilization Management Specialist RN - Patient Access in Fargo , North Dakota Job Title: Utilization Management Specialist RN Patient Access Multi-City City: Fargo State: ND Department : Patient Access Specialist - Sioux Falls or Fargo Job Schedule: Full Time, 40 hours a week, Monday-Friday weekday hours. Position can sit in either Sioux Falls or Fargo market. Shift: Days Hours Per Shift: 8 hr JOB SUMMARY Conduct level of care medical …

Behavioral Health Utilization Management Care Advocate - Atlanta, GA - UnitedHealth Group - Atlanta, GA | 9/9/2019

Share Description You’re looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We’re going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Bring your skills and talents to a role …

NantHealth’s Eviti Platform Again Granted Full URAC Accreditation, Through September 1, 2022 | 8/27/2019

… healthcare, always within URAC standard Culver City, CA – August 27, 2019 – NantHealth Inc. (NASDAQ: NH), a next-generation, evidence-based, personalized healthcare company, today announced that it has been granted full URAC accreditation for Health Utilization Management for its Eviti platform. NantHealth’s utilization management procedures have been accredited by URAC since 2010, with the last accredidation update in 2016. The recent accreditation extends URAC accreditation through September 1, 2022. In …

(USA-UT-Salt Lake City) Home Health Utilization Management RN | 8/4/2019

Job Information UnitedHealth Group Home Health Utilization Management RN in Salt Lake City , Utah Optum Medical Network is a network of health care providers in Utah, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network’s focus is to do the right things for patients, physicians, and the community. Optum Medical …

(USA-UT-Sandy) Home Health Utilization Management RN | 8/4/2019

Job Information UnitedHealth Group Home Health Utilization Management RN in Sandy , Utah Optum Medical Network is a network of health care providers in Utah, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network’s focus is to do the right things for patients, physicians, and the community. Optum Medical Network’s Core …

Behavioral Health Utilization Management Care Advocate Atlanta GA - UnitedHealth Group - Atlanta, GA | 7/5/2019

Share Description You’re looking for something bigger for your career. How about inventing the future of health care? UnitedHealthcare is offering an innovative new standard for care management. We’re going beyond counseling services and verified referrals to behavioral health programs integrated across the entire continuum of care. Our growth is fueling the need for highly qualified professionals to join our elite team. Bring your skills and talents to a role …

Case Manager - Boise, ID, , USA #jobs #Boise pls RT | 6/18/2019

… to create a Person-Centered Service Plan, provide information about eligibility and referrals, resources, services and supports covered under the 1915i State Plan Home and Community Bases Services benefit. Additionally, there will be Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The …

HMC HealthWorks™ White Paper Highlights the Human Touch Benefits for Patients’ Health and the Bottom Line | PR Newswire | 5/21/2019

… Solutions, Wellness/Lifestyle Coaching and Care Coordination, Pharmacy Benefit Advocacy programs, as well as its newly launched HealthWorks CareClinic+®. HMC HealthWorks is certified by the Women’s Business Enterprise, WBENC, and is urac ® accredited for Health Utilization Management . For more information, contact Staci McKelvey , Senior VP of Marketing & Communications of HMC HealthWorks. Email: [email protected] or call: 888-369-5054 SOURCE HMC HealthWorks Related Links http://www.hmchealthworks.com …

(USA-PA-Blue Bell) Behavioral Health Utilization Management Clinician | 5/9/2019

Aetna Behavioral Health Utilization Management Clinician in Blue Bell , Pennsylvania Req ID: 59506BR Work at Home - Hours will be 10:30am-7:00pm The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. A license to practice in the state …

(USA-PA-Allentown) Behavioral Health Utilization Management Clinician | 5/9/2019

Aetna Behavioral Health Utilization Management Clinician in Allentown , Pennsylvania Req ID: 59506BR Work at Home - Hours will be 10:30am-7:00pm The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. A license to practice in the state in …

(USA-PA-Bethlehem) Behavioral Health Utilization Management Clinician | 5/9/2019

Aetna Behavioral Health Utilization Management Clinician in Bethlehem , Pennsylvania Req ID: 59506BR Work at Home - Hours will be 10:30am-7:00pm The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. A license to practice in the state in …

(USA-VA-Arlington) Utilization Management, Chief Medical Officer | 4/24/2019

Evolent Health Utilization Management , Chief Medical Officer in Arlington , Virginia It’s Time For A Change… Your Future Evolves Here Evolent Health has a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to work each day. We believe in embracing new ideas, challenging ourselves and failing forward. We respect and …

(USA-MA-Winchester) Utilization Management Specialist | 4/20/2019

Lahey Health Utilization Management Specialist in Winchester , Massachusetts Welcome To Winchester Hospital is a leading community hospital north of Boston. The hospital offers a full range of medical services including maternity care and a Level IIB Special Care Nursery. Since 1912, Winchester Hospital has been a trusted pillar of the community and is recognized for outstanding quality and high satisfaction scores. In 2003, we became the first community hospital in …

(USA-CA-Hesperia) Utilization Management Assistant | 4/19/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Hesperia , California Providence St. Joseph Health- St. Joseph Heritage is looking for a Utilization Management Assistant to join the growing team. Hours and Shift: Monday through Friday 8 am to 5 pm Summary: Responsible for the distribution, review, accurate and timely processing of patient referrals requested from providers. Essential Functions: Responsible for verification of member’s eligibility and check benefits …

(USA-SC-Charleston) Behavioral Health Utilization Management Review | 4/18/2019

AmeriHealth Caritas Behavioral Health Utilization Management Review in Charleston , South Carolina Behavioral Health Utilization Management Review Location: Charleston, SC ID : 16641 Your career starts now. We’re looking for the next generation of health care leaders. At AmeriHealth Caritas, we’re passionate about helping people get care, stay well and build healthy communities. As one of the nation’s leaders in health care solutions, we offer our associates the opportunity to impact the …

Utilization Review

(USA-UT-Murray) Utilization Management Coordinator- Pended Claims | 11/26/2019

… title=”Refer this job to a friend” Refer this job to a friend /a I Job Information University of Utah Health Utilization Management Coordinator- Pended Claims in Murray , Utah Overview As a patient-focused organization … responsible for assisting with the coordination of case management clients, utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care …

(USA-UT-Murray) Utilization Management Coordinator | 11/4/2019

… window)” href=”http://icims.help” target=”_blank” Application FAQs /a p class=”iCIMS_Logo_Text” br Job Information University of Utah Health Utilization Management Coordinator in Murray , Utah Overview As a patient-focused organization, University of … responsible for assisting with the coordination of case management clients, utilization review, concurrent review and medical necessity review. Provides customer service and interaction with providers and members. This position is not responsible for providing care …

URAC

NantHealth, Inc. (NH) CEO Patrick Soon Shiong on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/11/2019

URAC which is valid through September 1 2022 the accreditation which recognizes those companies abiding by evidence-based standards and value-based care means Eviti continues to meet URAC health utilization management standards. For an NaviNet payers engagement solution we had an NaviNet Authorization attachment application through implementation of one of the nation’s largest health insurance organizations. This feature ensures providers receive the right supporting documentation to make more informed …

NantHealth Reports 2019 Third-Quarter Financial Results | 11/7/2019

URAC for the Eviti platform. Eviti continues to meet URAC Health Utilization Management standards, valid through September 1, 2022. The designation recognizes those companies abiding by evidence-based standards and value-based care Payer Engagement (NaviNet ® ): Added Navinet’s Authorization Attachment application to the NaviNet implementation for one of the nation’s largest health insurance organizations. This feature ensures providers receive the right supporting documentation to make more informed, timely decisions Expanded …

Clinical Decision Support

NantHealth, Inc. (NH) CEO Patrick Soon Shiong on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/11/2019

… and reflects our efforts to keep a close eye on our costs. Turning to software and service business, in our clinical decision support division we’ve renewed the partnership contract with the leading provider of clinical … and value-based care means Eviti continues to meet URAC health utilization management standards. For an NaviNet payers engagement solution we had an NaviNet Authorization attachment application through implementation of one of the nation’s largest …

NantHealth Reports 2019 Third-Quarter Financial Results | 11/7/2019

… and growing gross margin, all resulting in reduced cash burn and enhanced bottom line results.” Software and Services Q3 Highlights: Clinical Decision Support ( Eviti ® ): Renewed a partnership contract with a leading provider of clinical solutions … URAC for the Eviti platform. Eviti continues to meet URAC Health Utilization Management standards, valid through September 1, 2022. The designation recognizes those companies abiding by evidence-based standards and value-based care Payer Engagement …

Home Health

NantHealth, Inc. (NH) CEO Patrick Soon Shiong on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/11/2019

… accreditation which recognizes those companies abiding by evidence-based standards and value-based care means Eviti continues to meet URAC health utilization management standards. For an NaviNet payers engagement solution we had an NaviNet Authorization … of the prior year. As a reminder we divested our home health business at the end of 2019 second quarter. Consequently we did not record any revenues for this business in the current year of …

(USA-UT-Salt Lake City) Home Health Utilization Management RN | 8/4/2019

Job Information UnitedHealth Group Home Health Utilization Management RN in Salt Lake City , Utah Optum Medical Network is a network of health care providers in Utah, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network’s focus is to do the right things for patients, physicians, and the community. Optum Medical …

Clinical Documentation

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing … Performs preliminary review and assessment of referrals for completeness: Supporting clinical documentation for the referral request, ICD-10, CPT, and/or HCPC codes. Assists in gathering clinical information needed to substantiate the medical necessity of …

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing … Performs preliminary review and assessment of referrals for completeness: Supporting clinical documentation for the referral request, ICD-10, CPT, and/or HCPC codes. Assists in gathering clinical information needed to substantiate the medical necessity of …

Patient Referrals

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of coverage guidelines …

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals (DME referrals) requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of …

Behavioral Health

Case Manager - Roseburg, OR, , USA #jobs #Roseburg pls RT | 10/22/2019

… Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The position also supports Oregon Health Authority as they manage the appeals of determination process. Accountabilities Conducting face to face interviews with severely mentally ill people to create a Person-Centered Service Plan Provide …

Case Manager - Medford, OR, , USA #jobs #Medford pls RT | 10/22/2019

… Behavioral Health Utilization Management done by reviewing necessary clinical information, conducting the Level of Care Utilization System (LOCUS) and the Level of Service Inventory (LSI) as well as conducting eligibility redeterminations at least every 12 months. The position also supports Oregon Health Authority as they manage the appeals of determination process. Accountabilities Conducting face to face interviews with severely mentally ill people to create a Person-Centered Service Plan Provide …

NantHealth

NantHealth, Inc. (NH) CEO Patrick Soon Shiong on Q3 2019 Results - Earnings Call Transcript | Seeking Alpha | 11/11/2019

NantHealth, Inc. (NASDAQ: NH ) Q3 2019 Results Earnings 4:30 PM Robert Jaffe - Investor Relations Officer Ron Louks - Chief Operating Officer Bob Petrou - Chief Financial Officer Patrick Soon Shiong - Chief Executive Officer Dr. Sandeep Reddy - Chief … and value-based care means Eviti continues to meet URAC health utilization management standards. For an NaviNet payers engagement solution we had an NaviNet Authorization attachment application through implementation of one of the nation’s largest …

NantHealth Reports 2019 Third-Quarter Financial Results | 11/7/2019

… customer and renewed two customer contracts for a total contract value exceeding $40 million Culver City, Calif. – November 7, 2019 — NantHealth, Inc. (NASDAQ-GS: NH), a next-generation, evidence-based, personalized healthcare company, today reported … URAC for the Eviti platform. Eviti continues to meet URAC Health Utilization Management standards, valid through September 1, 2022. The designation recognizes those companies abiding by evidence-based standards and value-based care Payer Engagement …

UnitedHealth Group

Behavioral Health Utilization Management Care Advocate - Atlanta, GA - UnitedHealth Group - Atlanta, GA | 9/9/2019

… where you’ll have the opportunity to make an impact on a huge scale. Join us. Take this opportunity to start doing your life’s best work.(sm) What makes your clinical career greater with UnitedHealth Group ? You can improve the health of others and help heal the health care system. You will work within an incredible team culture; a clinical and business collaboration that is learning and evolving every day. And …

(USA-UT-Salt Lake City) Home Health Utilization Management RN | 8/4/2019

Job Information UnitedHealth Group Home Health Utilization Management RN in Salt Lake City , Utah Optum Medical Network is a network of health care providers in Utah, whose mission is to connect and support providers by working together to deliver the most effective and compassionate care to each and every patient they serve. Optum Medical Network’s focus is to do the right things for patients, physicians, and the community. Optum Medical …

St. Joseph Health

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of coverage guidelines …

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals (DME referrals) requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of …

Covenant Health

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of coverage guidelines …

(USA-CA-Anaheim) Utilization Management Assistant | 10/31/2019

Job Information St. Joseph Health / Covenant Health Utilization Management Assistant in Anaheim , California Job Summary: Under the direction of the Utilization Supervisor/ Manager, this position is responsible for the distribution, review, accurate and timely processing of SJHH patient referrals (DME referrals) requested from providers. Essential Functions: Responsible for verification of member’s eligibility (reporting to enrollment if not in IDX) and checks benefits of members for services requested per evidence of …

Aetna

(USA-PA-Blue Bell) Behavioral Health Utilization Management Clinician | 5/9/2019

Aetna Behavioral Health Utilization Management Clinician in Blue Bell , Pennsylvania Req ID: 59506BR Work at Home - Hours will be 10:30am-7:00pm The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. A license to practice in the state …

(USA-PA-Allentown) Behavioral Health Utilization Management Clinician | 5/9/2019

Aetna Behavioral Health Utilization Management Clinician in Allentown , Pennsylvania Req ID: 59506BR Work at Home - Hours will be 10:30am-7:00pm The Aetna Medicare BH UMC works within an integrated team to perform utilization review, as well as proactive discharge planning. This includes working in close collaboration with our business partners, as well as the enterprise to promote overall wellness for our members. A license to practice in the state in …