- Dignity Health (Los Angeles, CA)
- …and community. + Attends LA County DMH meetings and trainings pertaining to utilization review , billing and audit procedures, data entry, and reimbursement. + ... To be successful, you'll combine strong analytical and project management skills with a thorough understanding of QI principles,...meetings with clinical staff. + Conducts internal audit and utilization review activities on cases and informs… more
- HCA Healthcare (Nashville, TN)
- …collaborating with leadership and sourcing teams (VP, AVP, Contract Director , Contract Managers and Contract Analysts). Responsibilities include conducting ... The Sr. Analyst supports sourcing projects by coordinating the analytics team's review of multiple agreements within a category to establish financial and… more
- HCA Healthcare (Port St. Lucie, FL)
- … + experience or 2 years of critical care experience + Certification in case management or utilization review preferred + InterQual experience preferred HCA ... Rehab patient. The CM collaborates with the Rehab Program Director and Facility Case Management Director regarding departmental functions. The CM coordinates… more
- Johns Hopkins University (Baltimore, MD)
- …appropriate solutions and formulates sound reasonable recommendations for management 's corrective action, using appropriate criteria and cost-benefit considerations. ... shape priorities. + Negotiate audit parameters with Manager/ Sr. Director . + If leading a team, will ensure that...internal audit programs and time budgets based upon the review and evaluation of underlying financials and business risks.… more
- CommonSpirit Health (Phoenix, AZ)
- …responsibilities leading up to or including supervisory role + Experience in Utilization Management , Case Management or Care Coordination, Managed ... quality assurance reviews of work performed and communicating with department manager and director the outcomes of the review and any identified issues or… more
- Bon Secours Mercy Health (Norfolk, VA)
- …The Network Manager serves as the front-line driver of network growth, retention, and utilization to improve the quality of care in our markets. The Network Manager ... Roads, VA Market. **Essential Job Functions** + Collaborates with the market Director of Network Performance to successfully understand and drive market and system… more
- CommonSpirit Health (Rancho Cordova, CA)
- …leading up to or including supervisory role highly preferred + Experience in Utilization Management , Case Management or Care Coordination, Managed Care ... quality assurance reviews of work performed and communicating with department manager and director the outcomes of the review and any identified issues or… more
- NexTec Group (TX)
- …skill sets and within alignment of the Statement of Work, Business Process Review (BPR) documentation, and NexTec methodology. + Maintain at least 75 percent ... utilization on an average annual basis. + Maintain Acumatica...complexity. + Proactively communicate status, issues, and concerns to director , project manager, and/or architect/lead. + Provide coaching and… more
- NexTec Group (Seattle, WA)
- …to team members' skill set and within alignment of SOW, Business Process Review (BPR) documentation, and NexTec methodology. + Maintain 75 percent utilization ... status reports. + Follow Acumatica's implementation methodologies. + Achieve utilization targets while achieving high customer satisfaction. + Demonstrate expert… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …Technician (RBT) or Registered Line Technician (RLT) + Experience supporting utilization management processes or working with Electronic Health Records/Systems ... initiates authorization workflows, and appropriately routes cases to the BCBA Utilization Reviewer. + Communicates authorization decisions and procedural guidance to… more