- Humana (Phoenix, AZ)
- …supporting provider performance, and coordinating with cross-functional teams to drive quality, utilization , and cost-of-care outcomes. At the core, this is a role ... MRA, chronic condition management, and other efforts to reduce avoidable utilization * Supporting Joint Operating Committees (JOCs) and facilitating implementation… more
- Humana (Phoenix, AZ)
- …communication skills . + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Humana (Phoenix, AZ)
- …communication skills. + Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review organization, such… more
- Evolent (Phoenix, AZ)
- …+ Leading a team in the analysis and interpretation of cost and utilization data (medical and pharmaceutical) to explain potential upside/downside risks of a given ... track record of identifying insights from quantitative and qualitative data + Prior people management experience + Ability to work independently with limited… more
- Veterans Affairs, Veterans Health Administration (Goodyear, AZ)
- …orientation, competencies and providing quality improvement and outcomes utilization consultation. The psychiatric MH RN independently provides patient-centered ... subject to urinalysis to screen for illegal drug use prior to appointment. Applicants who refuse to be tested...or standing. Transferring patients and objects may be required. Utilization of safe patient handling and mobility protocols using… more
- Centene Corporation (Phoenix, AZ)
- …Track and trend overrides to ensure criteria have been met, audit for prior authorizations, analyze cost and determine utilization patterns + Resolve complaints ... and respond to provider and pharmacy calls regarding the prior authorization and formulary process + Perform review of...health plan's pharmacy process + Assist with the pharmacy utilization review and reporting process + Collaborate with Quality… more
- Leidos (Tucson, AZ)
- …technical teams. + Oversee TO performance, deliverable progress, and staffing utilization , with a continuous focus on driving operational efficiency, innovation, ... external stakeholders. + Track funding, burn rates, and contract ceiling utilization ; ensure proper resource allocation. + Oversee hiring, onboarding, retention, and… more
- CVS Health (Phoenix, AZ)
- …for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management and eligibility status. ... driven timelines.- Utilizes weekly and daily reporting to identify utilization for the purpose of reducing Emergency Department ...the subsequent care continuum until member can return to prior level of functioning in the community. - Facilitates… more
- Adelante (Surprise, AZ)
- …work with patients to develop self-management goals, provide insurance, referral, and prior authorization support, and may also conduct patient outreach to follow up ... + Prepare for the patient appointment by reviewing and updating patient records prior to patient arrival + Interview patient to obtain reason for visit: chief… more
- CDM Smith (Chandler, AZ)
- …of your team. - Coordinating workload within your Technical Services group and utilization goals for the individuals on your team. - Coordinating with your TDM ... a deep understanding of the business, including key metrics such as utilization , project profitability, overhead, and staffing. - Advanced knowledge of necessary… more