Sentences with phrase «utilization management»
"Utilization management" refers to the process of efficiently and effectively using resources or services, especially in the healthcare industry. It involves evaluating and controlling the utilization of medical treatments, procedures, or healthcare facilities to ensure appropriate and cost-effective care. Full definition
Current knowledge in medical terminology and knowledge of utilization management.
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Utilization Management Nurses make sure healthcare services are administered in an effective and compliant manner.
Despite having the broadest U.S. formulary coverage of any PCSK9 inhibitor, many patients have been unable to access Praluent because of the complicated utilization management process required by some insurance companies and high patient out - of - pocket costs.
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.
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.
BCBSIL is accredited through URAC for Health Utilization Management.
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.
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...
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.
• 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
Oversee retail supply maintenance and support, technical supply management, and accurately «tag» property utilizing barcode (REID - TAGS) property utilization management initiatives.
Assisted in obtaining company certifications including URAC Utilization Management Accreditation, New York State Utilization Review Agent Certification and DS Certification.
I also have a background in Managed Care Utilization Management for Outpatient and Residential levels of care.
Through a rigorous and comprehensive review that ensures ongoing compliance, ACM earned its URAC accredita - tion in Health Utilization Management.
Core Competencies Team Leadership • Communications • Staff Development / Mentoring • Process Streamlining • Customer Relations Operations Improvement • URAC Utilization Management • URAC Accreditation for Claims Processing
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.
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)...
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.
Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization management process.
A science graduate in care and nursing management with thorough knowledge and experience of monitoring and assessing patient treatment seeks a challenging role as an utilization management nurse in a reputed hospital.
Registered Nurse Case Manager Nurse The Arora Group, Inc. (AGI) has an immediate opening for a Registered Nurse Case Manager (RNCM) working in the Case Management Division and Utilization Management...
Interested in position in case management, utilization management and disease management with potential to telecommute or travel to facilities.
Ideal Companies: Health Insurance Organizations, Utilization Management, Travel Health insurance
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.
Tags for this Online Resume: Computer Aided Software Engineering, Management, Distribution, Medical, Health Care Industry, Integrate, Managed Care, Services, Utilization Management, Quality
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: 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: Management, Risk Management, Utilization Management, Insurance, Audit, Documentation, Risk Management Activities, Nursing, Complaints, Medical
Tags for this Online Resume: Consumer Products, Sales, Management, Account Management, Consulting, Drug Information, Drug Utilization, Therapy, Utilization Management, Long Term Care, pharmacist
Oversaw the activities of the Health Information Service Department, Utilization Management, and Medical Staff Services.
Tags for this Online Resume: Behavioral Health, Environmental Issues, Management, Referrals, Advertising, Communications, Microsoft Front Page, Solicitations, Treatment Goals, Utilization Management