- BlueCross BlueShield of North Carolina (NC)
- …and/or services of selected member populations. Provides guidance and promotes effective utilization and monitoring of health care resources to drive quality ... May outreach directly to members identified as high risk, high cost, or high utilization cases + May review alternative treatment plans for case management… more
- Evolent (Raleigh, NC)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...and maintain the definitive source of truth for specialty Utilization Management (UM) agreements. This important work is achieved… more
- Humana (Raleigh, NC)
- …claims submission and payment, utilization management processes, behavioral health processes, and dispute resolution. **Work at Home Requirements** ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Medicaid...timelines. + Submits required documents to state agencies for review and approval. + Regularly meet with Humana Healthy… more
- Evolent (Raleigh, NC)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... care, we seek to connect the pieces of fragmented health care system and ensure people get the same...in **Performance Suite risk arrangements with payers and strategic utilization management initiatives.** This is an opportunity for a… more
- Humana (Raleigh, NC)
- …with medical terminology and/or ICD-10 codes. + Member service + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... part of our caring community and help us put health first** The Bilingual Telephonic UM Coordinator / UM...moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid… more
- Evolent (Raleigh, NC)
- …to adeptly negotiate internally and externally around interpretation and application of utilization review law, accreditation standards and policy. + Ensures ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health … more
- Humana (Raleigh, NC)
- … first** The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works ... focused on continuously improving consumer experiences **Preferred Qualifications** + Medical utilization management experience + Working with health insurance… more
- HCA Healthcare (Asheville, NC)
- …**Benefits** Mission Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and ... 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.… more
- HCA Healthcare (Asheville, NC)
- …**Benefits** Mission Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and ... 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.… more
- HCA Healthcare (Asheville, NC)
- …**Benefits** Mission Hospital, offers a total rewards package that supports the health , life, career and retirement of our colleagues. The available plans and ... 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.… more