Utilization Management Jobs in Colorado (NOW HIRING)

Must have BSN, 3 years' experience in medical utilization management, and experience working with a health insurance plan. * Managed Care experience is preferred however hospital experience is also ...

This individual supports creation and maintenance of formulary and utilization management lists, preparation of CMS formulary files and member formulary drug lists, preparation and review of updates ...

Become a part of our caring community The Compliance Nurse 2 reviews utilization management activities and documentation to ensure adherence to policies, procedures, and regulations and to prevent ...

What you'll do Utilization Management & Review * Conduct prospective, concurrent, and retrospective utilization reviews to assess medical necessity, treatment appropriateness, and level of care

UR contacts external case managers/managed care organizations for certification of insurance ... A Utilization Review Specialist who excels in this role: * Displays knowledge of clinical criteria ...

UR contacts external case managers/managed care organizations for certification of insurance ... A Utilization Review Specialist who excels in this role: * Displays knowledge of clinical criteria ...

You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...

You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...

You will also require knowledge of utilization management processes and denial prevention strategies, actively collaborating with relevant System and Regional Directors to reduce preventable denials ...

They possess intimate knowledge of the internal referral care process, clinical review criteria, utilization management standards, clinical documentation requirements, community care regulations, and ...

Knowledge of value analysis methodologies, product standardization practices, and utilization management principles. * Ability to analyze clinical, operational, financial, and quality data to support ...

As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...

Workflows are outcomes oriented, and work will prioritize identification of high-risk members, proactive coordination of care with inpatient teams and health plan utilization management to meet ...

Works with Director, Utilization Management on other responsibilities, projects, and initiatives as needed * Responsible for adherence to the Capital Rx Code of Conduct including reporting of ...

Works with Director, Utilization Management on other responsibilities, projects, and initiatives as needed * Responsible for adherence to the Capital Rx Code of Conduct including reporting of ...

Provides focused support to various areas such as utilization management, value-based performance team, emergency department, acute, ambulatory, and specialty care teams. Duties include assessment to ...

Job Address: 4770 Larimer Pkwy Johnstown, CO 80534 New Vista Health and Wellness is currently recruiting a Utilization Review Coordinator! WHO WE ARE The New Vista mission: Inspiring Hope, Restoring ...

Provides focused support to various areas such as utilization management, value-based performance team, emergency department, acute, ambulatory, and specialty care teams. Duties include assessment to ...

Provides focused support to various areas such as utilization management, value-based performance team, emergency department, acute, ambulatory, and specialty care teams. Duties include assessment to ...