- Humana (Richmond, VA)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Richmond, VA)
- …and assists corporate leadership in strategic planning to improve effectiveness of behavioral health utilization management programs. + Collects and analyzes ... Humana Healthy Horizons in Virginia is seeking a Manager, Utilization Management (Behavioral Health ) who...this may be rare, it will happen._ **Work at Home Internet Statement** To ensure Home or… more
- CVS Health (Richmond, VA)
- …more personal, convenient and affordable. Position Summary The manager of Clinical Health Services Utilization Management will develop, implement, support, ... Bring your heart to CVS Health . Every one of us at CVS ...years in clinical area of expertise. + 3+ years Utilization Management experience + MS Office Suites… more
- Humana (Richmond, VA)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Qualifications** + Bachelor's Degree (BSN) + Utilization management experience is highly preferred + Health ...Medicare experience a plus + Milliman MCG experience preferred **Work-At- Home Requirements** To ensure Home or Hybrid… more
- CenterWell (Richmond, VA)
- …practice in a related specialty such as home infusion or specialty infusion, home health , oncology, IV therapy or critical care + Minimum 5 years nursing ... the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care...such as home infusion or specialty infusion, home health , oncology, IV therapy or critical… more
- Evolent Health (Richmond, VA)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes..., you will be a key member of the utilization management team. We can offer you… more
- CenterWell (Richmond, VA)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Evolent Health (Richmond, VA)
- …Be Doing:** As a Physician Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Richmond, VA)
- …human services, social sciences, or health related field. + Previous experience in utilization management , discharge planning and/or home health or ... who will lead a team of nurses and behavior health professionals responsible for care management of...(EST). + **Direct Reports:** Up to 15. **Work at Home Internet Statement** To ensure Home or… more
- Humana (Richmond, VA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- Humana (Richmond, VA)
- …Services and Supports (LTSS) who will lead teams of nurses and behavior health professionals responsible for care management . The Director, Care Management ... health goals. + Leads, develops, and operationalizes LTSS Care Management /Coordination within Humana's Population Health strategy, education, and Quality… more
- Humana (Richmond, VA)
- …corporate policies regarding other departmental areas such as medical management , utilization management , population health and quality. + May require ... part of our caring community and help us put health first** Humana Healthy Horizons in Virginia is seeking...Horizons in Virginia is seeking an Associate Director, Care Management (LTSS/ABD) who will lead teams of healthcare professionals… more
- ChenMed (Richmond, VA)
- …required. + A minimum of 1 year of utilization review and/or case management , home health , hospital discharge planning experience required. + A minimum ... other case managers and nurses, acute and post-acute facilities, home health care companies, and health...and post-acute setting. Coordinates the patient care, discharge and home planning processes with hospital case management … more
- CVS Health (Richmond, VA)
- …as optimization of medication selection, dosing, and monitoring + Experience with population health and/or disease state management + Ability to research and ... Bring your heart to CVS Health . Every one of us at CVS ...affordable. Position Summary: The Clinical Pharmacist performs retrospective drug utilization reviews. They distribute clinical drug information and educate… more
- Marriott (Richmond, VA)
- …and Vocational Rehabilitation for injured workers per regional guidelines. + Oversee Home Health and Field Case Managers. **Claims Services** + Collaborate ... to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources. Quality, cost...with Claims department regarding case management . + Collaborate with UNM on utilization … more
- Sharecare, Inc. (Richmond, VA)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Elevance Health (Richmond, VA)
- …Auth, and Benefits Management decision support in the Post-Acute Domain, DME, Home Health , and Wound Care. + Experience with Clinical guideline research and ... Develops and enhances relevant clinical guidelines. + Provides clinical leadership for Utilization Management , Case Management , Disease Management ,… more
- Humana (Richmond, VA)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... meets compliance timelines. **This is a full-time work from home opportunity. Candidates may live anywhere in the US...health insurance, other healthcare providers, clinical group practice management . + Utilization management experience… more
- Elevance Health (Richmond, VA)
- …role required by a State agency. **Preferred Skills, Capabilities, and Experiences:** + Utilization Management experience is a plus. + Ability to meet necessary ... **Medical Director** At **Federal Health Products and Services - FHPS** , a...clinical reviews. + The Medical Director typically has program management responsibilities including clinical policy development, program development/implementation, and… more
- ChenMed (Richmond, VA)
- …of care and cost effectiveness through the integrating and functions of case management , utilization review and discharge planning. The incumbent in this role ... management functions into the patient care, discharge and home planning processes with other departments, external service organizations, agencies and… more