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General knowledge of clinical programs, trends and medical management, medical care delivery systems, utilization management, disease management, analytics quality management, contracting, provider relations and customer service.
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Collaborate with AHCCCS and DDD, IHS and 638 Tribal Facilities to improve communication through the utilization of health information exchange (HIE) to improve coordination of care and health outcomes for American Indian members.
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The Case Manager (CM) / Utilization Review (UR) nurse staff augmentation full time role will temporarily fill in for Optum care management teams for short term staffing as well as provide consultative support to the front-line care management team, as appropriate.
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Utilization Review Nurse. Provides utilization management services, in coordination with other Case Management staff, providers, and other healthcare team members, using pre-established guidelines and criteria to perform review activities to assure the proper utilization of hospital services and payment of those services by Medicare, Medicaid, and other third-party payors.
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During each assignment, the role will provide comprehensive care management or utilization review services in various locations. Knowledge of Utilization Review, Medicare Requirements processes, as well as State and Federal regulations pertaining to Utilization Review and Discharge Planning.
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When naviHealth is delegated for utilization management, review referral requests that cannot be approved for continued stay and are forward to licensed physicians for review and issuance of the NOMNC when appropriate.
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Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.
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Works with the Landmark Health Medical Director, Director of Health Services, Corporate Director of Health Services, and UM staff in the development and/or implementation of medical management policy, clinical protocols, utilization management guidelines, and quality management programs.
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Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected.
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The Vice President is responsible for planning, organizing, and directing the administration of all Medical Management Programs such as Care Management (Utilization Management, Case Management, Disease Management), and Advance Care Management (Palliative Care) programs.
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Part of a team of dedicated actuaries and data scientists to study the usage of ML-based algorithms applied to historical pharmacy, inpatient notification data, prior authorization data and ultimate utilization and claims data to identify predictive capabilities that can enhance UHC’s current trend forecasting models.
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UnitedHealth Group is a drug-free workplace. Landmark Health was created to transform how healthcare is delivered to the most medically vulnerable members in our community. Awareness about UM standards, NCQA requirements, CMS guidelines, Milliman guidelines, and Medicaid/Medicare contracts and benefit systems.
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The Clinical Administrative Coordinator provides routine administrative support to Utilization Management Department. File data and perform other routine administrative tasks as assigned for other Utilization Management sub teams as needed.
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Perform utilization review determinations for radiation oncology populations, and support case and disease management teams to achieve optimal clinical outcomes. Demonstrated accomplishments in the areas of medical care delivery systems, utilization management, case management, disease management, quality management, product development and/or peer review.
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The Behavioral Health Case Manager is responsible for case management and utilization review of behavioral health and substance abuse services. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
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utilization job Company: Unitedhealth Group
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