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Molina Healthcare
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Richmond, Virginia
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, Healthcare Services provides operational management and oversight of integrated Healthcare Services (HCS ... productivity, cost effective utilization of services, management of targeted member population, and triage
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Humana
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Richmond, Virginia
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communication of medical services and/or benefit administration determinations. The Utilization Management Nurse ... !** The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent
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Humana
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Richmond, Virginia
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insurance, other healthcare providers, clinical group practice management.
Utilization management ... medical interpretation and determinations whether services provided by other healthcare professionals are
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ChenMed
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Richmond, Virginia
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services/case management functions into the patient care, discharge and home planning processes with other ... resource utilization, discharge planning and psychosocial aspects of healthcare delivery.
Promotes
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Humana
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Richmond, Virginia
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position with responsibility for utilization management and clinical decision-making as outlined in the ... **
Tasks include, but are not limited to:
70% : Performing utilization management activities for
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Humana
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Richmond, Virginia
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influence providers, members, market partners, and utilization management vendors. The work will require the ... Humana insurance services and CenterWell healthcare services, we make it easier for the millions of
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HCA Healthcare
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Richmond, Virginia
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**
Executives thrive with us! HCA Healthcare is one of the nation’s leading providers of healthcare services ... . Do you want to be an influencer in healthcare? **Apply for our Director Surgical Services role today
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Elevance Health
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Richmond, Virginia
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requests to utilization management with documentation supporting and aligning with the individual’s care ... complications).
Engages the primary service coordinator and other clinical healthcare management and
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HCA Healthcare
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Richmond, Virginia
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Description
Introduction
Last year our HCA Healthcare colleagues invested ... coverage that covers many common services at no cost or for a low copay. Plans include prescription drug
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Humana
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Richmond, Virginia
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communication of medical services and/or benefit administration determinations. The Utilization Management Nurse ... the appropriate courses of action.
The Utilization Management Nurse 2/Home Health Utilization
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Humana
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Richmond, Virginia
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, utilization management, case management, discharge planning and/or home health or post acute services such as ... medical interpretation and determinations whether services provided by other healthcare professionals are
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KEPRO
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Richmond, Virginia
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Proficiency in DSM-5-TR, adeptness in utilization management procedures, and extensive experience ... through technology, services, and clinical expertise. Our mission is to innovate health solutions that
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HCA Healthcare
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Richmond, Virginia
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services, HCA Healthcare.
Benefits
HCA Healthcare, offers a total rewards package that ... clinical operations and/or healthcare management
Participative management style and an ability to work
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Elevance Health
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Richmond, Virginia
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coordinates those member's cases with the clinical healthcare management and interdisciplinary team in order ... insure cost effective and efficient utilization of services.
Establishes short and long term goals
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HCA Healthcare
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Richmond, Virginia
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(https://henricodoctors.com/) has provided quality healthcare services to the Richmond community since ... covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral
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ChenMed
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Richmond, Virginia
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the integration of social services/case management functions in the pre-acute, ER, acute and post ... management departments, and other healthcare facilities.
In conjunction with the PCP, Hospitalist
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CVS Health
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Richmond, Virginia
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Position Summary
This Utilization Management (UM) Nurse Consultant role is fully remote and employee ... facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the
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Humana
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Richmond, Virginia
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, utilization management, case management, discharge planning and/or home health or post acute services such as ... interpretation and determinations whether services provided by other healthcare professionals are in agreement
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CVS Health
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Richmond, Virginia
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healthcare to establish competitive business advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management, quality management, network management and clinical
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CVS Health
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Richmond, Virginia
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— our purpose sends a personal message that how we deliver our services is just as important as what we ... .
Position Summary Utilizes skills to coordinate, document and communicate all aspects of the utilization
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Humana
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Richmond, Virginia
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and determinations whether services provided by other healthcare professionals are in agreement with ... prior experience participating in teams focusing on quality management, utilization management, case
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HCA Healthcare
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Richmond, Virginia
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common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.
Additional
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Oracle
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Richmond, Virginia
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Energy & Utilities
Financial Services
Healthcare
Strategic Accounts/Pursuits
Direct ... and management of OCI resources, ensuring consistency and efficiency.
**Security and Compliance
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Molina Healthcare
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Richmond, Virginia
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consider any applicant within the United States
Job Summary
Molina Healthcare Services (HCS ... , Association**
Active, unrestricted Utilization Management Certification (CPHM).
To all current
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Humana
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Richmond, Virginia
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participating in teams focusing on quality management, utilization management, case management, discharge ... Systems, health insurance, other healthcare providers, clinical group practice management
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Highmark Health
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Richmond, Virginia
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patient, and then creates the case (data entry) in Highmark's utilization management system for clinical ... utilization management system.
Use knowledge of process and judgement to evaluate identified cases that
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KEPRO
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Richmond, Virginia
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Proficiency in DSM-5-TR, adeptness in utilization management procedures, and extensive experience ... through technology, services, and clinical expertise. Our mission is to innovate health solutions that
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HCA Healthcare
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Richmond, Virginia
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, including position control, scheduling excellence, productivity management, and premium pay utilization ... offers a full range of healthcare services, with specialties in trauma, cardiovascular and neurological
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Sharecare, Inc.
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Richmond, Virginia
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appropriate total healthcare management.
RD colleague is supervised by an Operations Manager. All Sharecare ... of the care enhancement program by providing telephonic care and resource utilization for members in
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J&J Family of Companies
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Richmond, Virginia
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management services
GPLA program is handled in positive partnership with a global external provider. The ... progress. As the world’s largest and most broadly-based healthcare company, we are committed to using our
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