Utilization Management

Selected news for the healthcare topic - Utilization Management, collected since 10/2017. There are 1.9K items in the archive. This healthcare topic shares news with Case Management, Prior Authorization, UnitedHealth Group, UnitedHealth, Medicaid and over a hundred others.

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5/9/2022 Utilization Management Coordinator – Fairfax Behavioral Health – Kirkland, WA medacura.com Quality healthcare is our passion, improving lives is our reward. Join us as we work to change lives and transform the delivery of healthcare.The Utilization Management Coordinator performs all functions related to hospital resources and reimbursement. Utilization Management functions as liaison between payors, the business office, and treatment team, providing information and feedback to assist in optimum patient care and reimbursement.Education:- Master’s degree from an accredited college ...
5/8/2022 Utilization Management Nurse, RN (Remote) – Inland Empire Health Plans – Rancho Cucamonga, CA medacura.com Position Summary/PositionUnder the general direction of the Utilization Management Manager, the Utilization Management Nurse is responsible for prospective and concurrent/retrospective review of referrals ensuring regulatory requirements are being met as they relate to language readability and appropriate citation of criteria in Member correspondence. This position is responsible to ensure meeting Member’s needs using nationally recognized UM criteria. Major Functions (Duties and Responsibilities)1. Responsible for reviewing ...
5/6/2022 RN Utilization Review Coordinator - Utilization Management hound.com RN Utilization Review Coordinator - Utilization Management Company MEMBERS ONLY SIGN UP NOW Job Description RN Utilization Review Coordinator - Utilization Management','355873','On Call','Day','Case Management','Oregon-Portland','9205 Sw Barnes Road','','Portland','97225','Oregon-Portland','! !RN Utilization Review Coordinator at St Vincent's Medical Center, this will be for an On-call positionThe RN Coordinator-Utilization Review supports the care of the patient through assessment, planning, implementation and evaluation of ...
5/5/2022 MC-Rx Becomes Primary Pharmacy Benefits Management Organization in ProCare Family of Companies PR Newswire ... as a third-party administrator of prescription drug programs for commercial health plans, self-insured employer plans, Medicare & Medicaid programs, among others. MC-Rx is responsible for creating cost-effective healthcare by offering clinical utilization management programs, offering more affordable pharmacy channels, negotiating discounts with drug manufacturers and retail drugstores, and encouraging the use of low cost generics and affordable brands. MC-Rx manages the processing and paying of prescription ...
5/5/2022 Cohere Health Receives 2022 KLAS Points of Light Award PR Newswire Successful collaboration honored for reducing the burden of prior authorization and speeding patient access to quality careBOSTON , May 5, 2022 /PRNewswire/ -- Today Cohere Health, a recognized leader in utilization management (UM) technology, was named a winner of the KLAS 2022 Points of Light award, which recognizes successful payer, provider, and vendor collaborations that reduce cost and inefficiency and deliver a better patient experience. KLAS recognized Cohere's intelligent UM collaboration ...
5/3/2022 Toney HealthCare Launches Utilization Management 360® Platform to Power High Performing Clinical Revenue Cycle Management globalbankingandfinance.com Integrated information and process management platform enables a holistic, centralized approach to clinical documentation to overcome revenue cycle inefficiencies.TAMPA, Fla. Toney HealthCare Consulting (THCC) is launching Utilization Management 360 ® (UM360), a clinical revenue cycle management platform that helps healthcare providers harness patient care information holistically to make the billing process more efficient while improving the quality and safety of patient care. The platform is a provider-oriented case ...
5/3/2022 ALLMED EARNS URAC REACCREDITATION IN IRO COMPREHENSIVE REVIEW: INTERNAL & EXTERNAL, VERSION 5.2 AND HEALTH UTILIZATION MANAGEMENT VERSION 7.4 PR Newswire The designations demonstrate the highest level of commitment to quality healthcarePORTLAND, Ore. , May 3, AllMed Healthcare Management, Inc., a leading provider of utilization management (UM) and independent review (IRO) services, is proud to announce that it has earned URAC reaccreditations for both IRO Comprehensive Review: Internal & External, Version 5.2 and Health Utilization Management, Version 7.4. URAC is the independent leader in promoting health care quality by setting high standards ...
5/3/2022 Toney HealthCare Launches Utilization Management 360® Platform to Power High Performing Clinical Revenue Cycle Management PR Newswire Integrated information and process management platform enables a holistic, centralized approach to clinical documentation to overcome revenue cycle inefficiencies.TAMPA, Fla. Toney HealthCare Consulting (THCC) is launching Utilization Management 360 ® (UM360), a clinical revenue cycle management platform that helps healthcare providers harness patient care information holistically to make the billing process more efficient while improving the quality and safety of patient care. The platform is a provider-oriented case ...
5/2/2022 Laboratory Utilization Management: Tick-Borne Disease Testing mayocliniclabs.com Laboratory Utilization Management: Tick-Borne Disease TestingHot TopicExpires: May 2, 2022Elitza Theel, Ph.D.Professor of Laboratory Medicine and PathologyDirector, Infectious Diseases Serology LaboratoryDivision of Clinical MicrobiologyMayo Clinic, Rochester, MinnesotaHello everyone. My name is Elli Theel, I am the director of the Infectious Diseases Serology Laboratory here at Mayo Clinic in Rochester, Minnesota.Today I will be talking about laboratory utilization management, specifically for ...
4/30/2022 Utilization Management Nurse Specialist RN II – L.A. Care Health Plan – Los Angeles, CA medacura.com The Utilization Management Nurse Specialist RN II will facilitate, coordinate and approve of medically necessary referrals that meet established criteria. Assures timely and accurate determination and notification of referrals and reconsiderations based on the referral determination status. Generates approval, modifications and denials communications, to include member and provider notification of referral determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or on site admission and concurrent review ...
4/25/2022 Magellan Healthcare Announces New Collaboration with Concert Genetics to Improve Genetic Testing | Business Wire Business Wire ... a software and managed services company that provides the data and digital infrastructure to manage genetic testing. Working together, the two companies will offer an innovative, end-to-end solution that leverages Magellan’s utilization management processes and claims integrations to deliver efficient management, improved quality, and accurate payment in genetic testing.The genetic testing landscape has changed dramatically and continues to evolve. With more than 175,000 orderable tests on ...
4/13/2022 Employer Utilization Management Tactics Place Healthcare Benefits Cost Before Patient Care, Survey Finds globalbankingandfinance.com When employers base health insurance decisions on cost alone, their employees suffer the consequencesNEW YORK , April 13, 2022 /PRNewswire/ — Utilization management (UM) tools may be effective in controlling short-term organizational costs, but they are not as effective in controlling health care costs for employees and can even serve as barriers to treatment, according to a new survey of large employers by Cancer Care , the leading national cancer ...
4/13/2022 Employer Utilization Management Tactics Place Healthcare Benefits Cost Before Patient Care, Survey Finds negotiamini.com Healthcare By Curation Bot On Apr 13, 2022 0 Share When employers base health insurance decisions on cost alone, their employees suffer the consequences NEW YORK, April 13, 2022 /PRNewswire/ — Utilization management (UM) tools may be effective in controlling short-term organizational costs, but they are not as effective in controlling health care costs for employees and can even serve as barriers to treatment, according to a new survey ...
4/5/2022 Utilization Management Coordinator – 12hrs/Wk – University of Utah Health – Salt Lake City, UT medacura.com ... patient outcomes.Responsibilities- Receives medial reviews and pended claim requests and data enters it into IDX.- Prepares paperwork for RN or MD review.- Communicates the results of the review to the requestor.- Answers the utilization management phone and fields calls for the case managers.- Assists providers and members by quoting benefits, verifying eligibility and answering questions about appeals.- Creates a case in IDX for all hospital admissions.- Assists the concurrent ...
2/18/2022 UCare: Utilization Management Liaison - MSS Star Tribune ... Line; including answering crisis calls for members who may need triage and referral to crisis resources. Identify and refer members that would benefit from case management services.• Serve as a liaison between the utilization management department, providers, behavioral health medical director, claims, A&G, PRC, provider assistance and customer services to resolve issues.• Expert resolution skills by responding, resolving or de-escalating member and provider inquiries regarding authorizations ...
2/18/2022 Leading Payor CFO Himanshu Shah Joins MedReview | Business Wire Business Wire NEW YORK--( BUSINESS WIRE )--MedReview, Inc., a leading provider of payment integrity, utilization management and quality surveillance services, is pleased to welcome Himanshu R. Shah as its new chief financial officer . A certified public account and information systems auditor, Shah oversees the company’s finance and accounting functions including cost accounting and reporting, financial planning and analysis, cash flow management, financial reporting and the implementation of new processes and controls ...
2/18/2022 Leading Payor CFO Himanshu Shah Joins MedReview Business Wire NEW YORK--(BUSINESS WIRE)--Feb 18, 2022--MedReview, Inc., a leading provider of payment integrity, utilization management and quality surveillance services, is pleased to welcome Himanshu R. Shah as its new chief financial officer . A certified public account and information systems auditor, Shah oversees the company’s finance and accounting functions including cost accounting and reporting, financial planning and analysis, cash flow management, financial reporting and the implementation of new ...
2/18/2022 LIBERTY Dental Plan Corporation Awarded NCQA Accreditation in Utilization Management and Credentialing | Business Wire Business Wire IRVINE, Calif.- LIBERTY Dental Plan Corporation (LIBERTY), one of the nation’s premier dental benefits administrators, announced that it has successfully completed accreditation by the National Committee for Quality Assurance (NCQA) for Utilization Management and Credentialing. Each designation is valid for three years.“NCQA accreditation is an important milestone in our organization’s 20-year history. We are so proud to be recognized for meeting industry best practices,” explained ...
2/17/2022 GuideWell and Olive Debut First-Of-Its-Kind AI Solution to Accelerate Access to Health Care PR Newswire ... This partnership will transform a frustrating, labor-intensive process, accelerating GuideWell's mission to help people and communities achieve better health through innovation and collaboration."Olive's AI platform helps GuideWell create a best-in-class utilization management model that reduces the administrative burden on our providers while creating a better experience for our members," said Dr. Elana Schrader , Florida Blue senior vice president, healthcare services and GuideWell Health president. "By being ...
2/17/2022 WellBe Senior Medical Announces Additions to Executive Team PR Newswire ... of Chicago Booth School of Business.Prior to joining WellBe Senior Medical, Alvina gained considerable experience in delivering value-based care with CareMore Health. She had corporate responsibility for Medicare Star Rating, Quality and Utilization Management departments across all CareMore markets and clinical models. Alvina played a key role in driving 4+ Star Rating performance and generating revenue reallocated into healthcare services and benefits for patients.Alvina earned her master's ...