- Molina Healthcare (Kenosha, WI)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... The Pharmacist, UM will be responsible for reviewing coverage determinations and appeals in a timely, compliant, and accurate manner. The Pharmacist, UM will… more
- Banner Health (WI)
- ** Department Name:** Denial Recovery-Corp **Work Shift:** Day **Job Category:** Revenue Cycle **Estimated Pay Range:** $37.14 - $61.90 / hour, based on location, ... place to work and receive care. As an Associate Manager of RN Denials Management, you will be an...leadership in clinical, financial, and personnel management within the department to result in overall reduction in payer clinical… more
- Humana (Madison, WI)
- …implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults ... strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and value-based payment programs. The… more
- Elevance Health (Neillsville, WI)
- …resolution through direct contact with providers, claims, pricing and medical management department . + Identifies and reports on provider utilization patterns ... issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. **How you will make an impact:** +… more