Utilization Management

Selected news for Utilization Management, representing 1% of data collected since 10/2017. Recent stories appear in PR Newswire and BioSpace. This healthcare topic shares news with UnitedHealth Group, Case Management, UnitedHealth, NCQA, Optum and over a hundred others.

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Date Headline (link) Source Relevant Snippet
1/1/2021 Senior Actuarial Analyst, ALDP - Telecommute - UnitedHealth Group - Shelton, CT actuary.com ... within United States as you take on some tough challenges. Primary Responsibilities: Maintain models used in valuation of hospital contracting Support analysis to evaluate contracting strategies Develop financial models to assess the efficacy of utilization management programs Ad-hoc medical claims-based analytics on various economic scenarios related to medical drug utilization Conduct therapy specific studies Analytics and modeling supporting pharmacy programs that are launching Provide contracting support to network ...
12/29/2020 HealthEdge Software Completes Acquisition of Altruista Health tmcnet.com ... claim payment automation with business intelligence, enabling a unified approach to ensure payment accuracy. Altruista offers customers a highly configurable set of comprehensive modules delivered as a SaaS ( News - Alert ) solution spanning care management, utilization management , population health, appeals and grievances, medication therapy management, member engagement and reporting and compliance. HealthEdge has provided care management and utilization management software integrated with HealthRules Payor® since 2012, and acquiring Altruista amplifies ...
12/25/2020 RN Clinical Quality Analyst WellMed San Antonio TX - UnitedHealth Group - San Antonio, TX insurancejobs.com ... passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work.(sm) The Regulatory Adherence Utilization Management (RA UM) Sr. Clinical Quality Analyst is responsible for monitoring and reporting compliance issues with Utilization Management (UM) Organization Determinations Appeals and Grievances for oversight of health plan delegated reports, and internal and external ...
12/23/2020 Senior Care Advocate Utilization Management- West Valley, UT - UnitedHealth Group - West Valley, UT insurancejobs.com Senior Care Advocate Utilization Management- West Valley, UT Senior Care Advocate Utilization Management- West Valley, UT UnitedHealth Group West Valley, Utah, United States 23 hours ago Apply NowDescription You're looking for something bigger for your career. How about inventing the future of health care? Optum 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 ...
12/21/2020 Behavioral Medical Director California - UnitedHealth Group - San Diego, CA insurancejobs.com ... entire continuum of care. Join us and help people live healthier lives while doing your life's best work.(sm) The Behavioral Medical Director position is responsible for providing oversight to and direction of the Utilization Management Program and performing peer reviews as necessary. This individual will interact directly with Psychiatrists, Behavioral Health Providers, and other clinical professionals who consult on various processes and programs. The Behavioral Medical Director is part ...
12/18/2020 Hospital Claim Denials Up for Most, Driven by Prior Authorizations allzonems.com ... issues driving the recent increase, according to a new report from the American Hospital Association (AHA).For the report, AHA surveyed more than 200 hospitals and health systems in 2019 to understand the impacts utilization management practices employed by commercial health plans had on patients and providers. The group also interviewed several hundred hospital and health system executives.The survey found that 89 percent of hospital and health system respondents ...
12/17/2020 Care Management Solutions Market worth $19.28 billion by 2023 express-press-release.net ... disease management solutions are expected to account for the largest share of the market in 2018 On the basis of applications, the care management solutions market is broadly segmented into disease management, case management, utilization management , other applications. In 2018, the disease management segment is expected to account for the largest share of this market. The high growth in this segment can be attributed to the ability of these solutions ...
12/15/2020 Care Management Solutions Market - Projected Growth in the Revenue by 2023 prsync.com ... disease management solutions are expected to account for the largest share of the market in 2018 On the basis of applications, the care management solutions market is broadly segmented into disease management, case management, utilization management , other applications. In 2018, the disease management segment is expected to account for the largest share of this market. The high growth in this segment can be attributed to the ability of these solutions ...
12/14/2020 CMS Proposes Rule to Streamline Prior Authorization, Data Exchange EHR Intelligence ... boost patient data exchange and streamline prior authorization to alleviate clinician burden.Additionally, the rule would allow providers to improve patient care and spend more time with their patients.Prior authorization is a key utilization management strategy many healthcare payers use to ensure patients access the most clinically and cost-effective medication available to them. When a drug has prior authorization requirements, the provider must submit certain documents to a ...
12/12/2020 UTILIZATION MGMT SPEC – Gateway Foundation Inc – Chicago, IL medacura.com ... the insurance authorization process Assisting staff with preparing peer-to-peer reviews and clinical appeals by advising them on presenting case information in accordance with established procedures Preparing regular summary reports and presentations on utilization management data Other duties as assignedJob Requirements: Current IL licensure as a Registered Nurse; or Masters’ degree in social work, psychology, mental health or substance abuse counseling and certification (CADC) or licensure (LPC ...
12/11/2020 Cade Saurage Joins Ocean Recovery as New COO, Effective November 2020 Business Insider NEWPORT BEACH, Calif. , Ocean Recovery announces Cade Saurage , 19-year industry veteran, as Chief Operating Officer, beginning November 2020 . Mr. Saurage has been serving as the Director of Utilization Management and Strategic Partnerships for Esperanza Health Group / La Hacienda Treatment Center since August of 2012."I am familiar with the solid reputation and tremendous work that Ocean Recovery is known for," said Mr. Saurage. "I really anticipate endless opportunities to ...
12/11/2020 Medical Director Clinical Advocacy and Support Telecommute - UnitedHealth Group - Chandler, AZ insurancejobs.com ... and maintain clinical and operational processes related to benefit coverage determinations, quality improvement and cost effectiveness of service for members. The Medical Director's activities primarily focus on the application of clinical knowledge in various utilization management activities with a focus on pre-service benefit and coverage determination or medical necessity (according to the benefit package), and on communication regarding this process with both network and non-network physicians, as well ...
12/10/2020 Geographic Direct Contracting: Where Hospice Fits hospicenews.com FacebookThrough the U.S. Centers for Medicare & Medicaid Services (CMS) forthcoming geographic direct contracting model, participating entities will step into the role of payer as well as provider, including responsibility for program integrity and utilization management . The best opportunity for hospices that wish to be involved would be to establish preferred provider relationships with direct contracting entities (DCEs).The demonstration will test whether a geographic-based approach to value-based ...
12/10/2020 Utilization Management and the Path to Automation mcg.com ... are both forced to spend enormous time and money on care approval processes. These processes are burdensome, disconnected, and can compromise the patient experience – as they did for my wife. Prior Authorization and Utilization Management Prior authorization is one example of utilization management or UM, which is defined by the National Academy of Medicine (formerly known as the Institute of Medicine) as “a set of techniques used by or ...
12/8/2020 In Letters to President-Elect Biden, ASCO Urges Action on Cancer Care and Research Priorities asco.org ... achieved through the passage of the bipartisan CLINICAL TREATMENT Act or through regulatory action at the Centers for Medicare & Medicaid Services (CMS). Protect the sanctity of doctor-patient decision making by reining in inappropriate utilization management protocols. Specifically, the letter calls on the incoming Administration to reverse the use of step therapy policies in Medicare Advantage plans and to pursue regulatory action to protect patients from unnecessary delays in care ...