Sentences with phrase «urac utilization management»

Express Scripts hailed the decrease as «the latest chapter of an ongoing success story for our utilization management programs.»

RxAdvance's holistic platform manages specialty pharmaceuticals from end - to - end, employing the following ten - steps: Specialty Formulary Management, Specialty Network Management, Physician Education, Utilization Management, Prior Authorization Management, Procurement Management, Adjudication Management, Case and Concurrent Management, Financial Reconciliation, Monitoring and Measuring.

This is a significant simplification compared to many current utilization management processes that involve multiple steps and lengthy documentation, including submitting laboratory results and detailed patient histories.

One of the nation's premier healthcare benefits providers, Aetna has offered remote work for utilization management clinicians, informatics analysts, healthcare quality analysts, field case managers, digital solution architects, registered nurses, and community relations managers.

Christine Hall - Finney, director of the Department of Health's Division of Provider Relations and Utilization Management, noted that the clinic's Medicaid service delivery is managed by Espada and his son Pedro G. Espada.

Genex» utilization management, peer review, case management, and related offerings are very similar to Mitchell's.

Once we have confirmed receipt of your request, our utilization management and review team will review the information provided and should respond to the insured person or the provider within two business days.

Once we have confirmed receipt of your request, our utilization management and review team will review the information provided and respond to the insured person or the provider within 2 business days.

Gathers clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case management, QI, Med Review)...

Utilization Management Nurses make sure healthcare services are administered in an effective and compliant manner.

Main job duties and responsibilities seen on a Utilization Management Nurse resume sample are reviewing patient clinical information, monitoring staff, advocating quality care, finding ways to prevent patient complications, and maintaining accurate records of patient interactions.

Successfully supported the implementation of Tapestry Utilization Management as a subject matter expert for referrals.

Review services and complete utilization management activities.

In December 2012, promoted from CDO Accounting Specialist to Utilization Management Specialist / Medicaid Accounting Specialist

Professional Skills • Skilled in accounts payable and general accounting • Good computer skills • Excellent communication skills • Familiar with Utilization Management and URAC standards

Name Of Position: UTILIZATION MANAGEMENT COORDINATOR Hours of Work: Monday through Friday; 7:00 am - 3:00 pm Requirements: RN or LPN PURPOSE: Under the direction and supervision of the Director of...

Create Resume More than 14 years» diverse leadership experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs and coaching medical staff on healthcare business and practice issues.

Tags for this Online Resume: case management, disease management, administer benefits, utilization management, medical coding, referral management

Tags for this Online Resume: Clinical Programs, Inventory, Therapy, Appraisals, Assessments, Management, Utilization Management, Drug Utilization, Pharmaceutical, Call Center

Tags for this Online Resume: Registered Nurse, Utilization Management, Call Centers, Occupational Health, Microsoft Office Suite, Managed Care, Process Improvement, Training and Development

Possess over 25 years diverse nursing background, 15 years Hospital and Managed Care Case Management / Utilization Management.

To secure a position with a well - established organization with advancement opportunities utilizing my skills in the field of Case Management Utilization Management and years of Nursing Experience.

Tags for this Online Resume: Policies and Procedures, Referrals, Behavioral Health, Microsoft PowerPoint, Planning, Social Service, Strategic Planning, Utilization Management, DFS, HIV, social services, non-profit, mental health, lcsw, substance abuse, social work, casac, case management, nonprofit, behavioral health clinical director

Tags for this Online Resume: ACLS, BLS, Catheter, Cesarean Section, Management, Nursing, Patient Education, Phlebotomy, Science, registered nurse, Educator, Case Management, Utilization Management

Tags for this Online Resume: Management, Risk Management, Utilization Management, Insurance, Audit, Documentation, Risk Management Activities, Nursing, Complaints, Medical

Oversaw the activities of the Health Information Service Department, Utilization Management, and Medical Staff Services.

• Knowledge and experience in the design, implementation and analysis of health care quality and cost data studies for quality improvement and appropriate cost - containment, resource utilization analysis, physician profiling, HEDIS, NCQA and QARR reporting • Microsoft Office Professional Suite (Word, Excel, Access, Outlook) • Proficient in application of Utilization Management Guidelines, including Milliman, Robertson and InterQual

Assisted in obtaining company certifications including URAC Utilization Management Accreditation, New York State Utilization Review Agent Certification and DS Certification.

MediSys Health Network, New York • NY 2006 — Present Director, Utilization Management Spearheaded operations for 3 non-profit hospitals, with a 10,000 employee system.

Experienced URAC Utilization Management team member and provider of new business development with strict adherence to all regulatory compliance.

Tags for this Online Resume: Behavioral Health, Environmental Issues, Management, Referrals, Advertising, Communications, Microsoft Front Page, Solicitations, Treatment Goals, Utilization Management

Tags for this Online Resume: Documentation, Basic Care, BASIC Programming Language, First Aid, Insurance, Medical, Medical Records, Occupational Therapy, Team Player, Therapy, Utilization management, Facility Site Review, Advanced Imaging, HEDIS, Case Management, Patient Advocates, Medi - Care, Medicaid, Healthcare insurance company, Quality Assurance and Improvement, ICD, CPT coding, Insurance Health plan Collaboration, Problem resolution and Solution distribution, outpatient rehabilitation, nurse, healthcare, outpatient physical therapy, physical therapy, physical therapist

Current knowledge in medical terminology and knowledge of utilization management.

The plan will use prior authorization and utilization management procedures to determine whether or not the term «medically necessary» is applicable.

UTILIZATION MANAGEMENT (UM) A system of procedures designed to ensure that the services provided to a specific client at a given time are cost - effective, appropriate, and least restrictive.

I also have a background in Managed Care Utilization Management for Outpatient and Residential levels of care.

Not exact matches

The primary responsibilities associated with human resource management include: job analysis and staffing, organization and utilization of work force, measurement and appraisal of work force performance, implementation of reward systems for employees, professional development of workers, and maintenance of work force.

In the modern context TQM is thought to require participative management; continuous process improvement; and the utilization of teams.

November 01, 2015 RxAdvance won Avera Health Plans» Pharmacy Benefit Management (PBM) contract to reduce overall pharmacy costs, avoidable drug - impacted medical costs, and optimize specialty drug utilization.

RxAdvance wins SMART Union Pharmacy Benefit Management (PBM) contract to reduce overall pharmacy costs, avoidable drug - impacted medical costs, and optimize specialty drug utilization.

RxAdvance won Avera Health Plans» Pharmacy Benefit Management (PBM) contract to reduce overall pharmacy costs, avoidable drug - impacted medical costs, and optimize specialty drug utilization.

May 19, 2017 RxAdvance wins SMART Union Pharmacy Benefit Management (PBM) contract to reduce overall pharmacy costs, avoidable drug - impacted medical costs, and optimize specialty drug utilization.

Credit bureaus are usually wary of seeing utilization rates that tip the scales above 30 % as it implies that you either don't have good money management skills, or that you may have difficulty repaying your debts.

Unlike most of our typical investment reports which focus on free cash flow utilization, net asset value investing, mean reversion of margins or special situations, this report will look at the investment merits of a company that generates little free cash flow at the moment and is somewhat of a growth investment if company management is successful in achieving its objectives.

Monitors efficiency in utilization and management of MASIPAG income generating facilities in the region; 5.

USCC promotes best management practices, establishes standards, educates professionals and the public about the benefits of composting and compost utilization, and enhances compost product quality, and trains composters and compost markets.

The sustainable management and utilization of natural resources, including land, water, air, climate and genetic resources for the benefit of present and future generations.

VIPColor Technologies is a leading - edge provider of innovative solutions for the production, management and utilization of package, product, promotion, logistic and location labels across industrial and retail supply chains.

Cost savings, improved management practices, consistent food, better equipment utilization, reduced energy costs, and increased employee engagement and morale are some of the benefits an IoT user can enjoy — sometimes by deploying even just a relatively budget - friendly smartphone app.

The 2016 Management and Utilization of District Assemblies» Common Fund, and other Statutory Funds reports released by the Auditor General, has revealed that among the 216 Assemblies across the ten regions of Ghana, assemblies in the Greater Region mismanaged the least of funds that were allotted them.