- Commonwealth Care Alliance (Boston, MA)
- …discipline, prior experience as Associate Medical Director (or equivalent) or physician reviewer in a Managed Care Plan preferred. **Required Knowledge, Skills ... Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for… more
- Providence (Missoula, MT)
- **Description** The Quality Management Reviewer assesses all hospital scheduled procedures and applies guidelines as established by the hospital and outside payer ... while adhering to the patient focused admission process. The Quality Management Reviewer demonstrates job related skills in a safe, appropriate, effective and timely… more
- JPMorgan Chase (Jersey City, NJ)
- …Investment Bank, Wealth Management, and Business Banking lines of business! As a Credit Review Vice President within our Credit Review team, you will take the ... in planning and executing periodic credit reviews, as well as participating in review assignments. Your role will involve guiding team members in activities that… more
- The Cigna Group (Bloomfield, CT)
- The Risk Adjustment Quality & Review Analyst in IFP brings medical coding and Hierarchical Condition Category expertise to the role, evaluates complex medical ... policy determinations, as needed. Education & Experience: The Quality Review & Audit Analyst will have a high school...to be eligible to participate in an annual bonus plan . We want you to be healthy, balanced, and… more
- Terracon (Omaha, NE)
- …will also review drawings and construction to assure compliance with plans and specifications. You will prepare proposals and cost estimates, track and evaluate ... will also review drawings and construction to assure compliance with plans and specifications. You will prepare proposals and cost estimates, track and evaluate… more
- The Cigna Group (Bloomfield, CT)
- …Matrix Partners, as required, to develop and promote shared goals. The Quality Review and Audit Senior Analyst position recognizes experience in Risk Adjustment Data ... This role is also anticipated to be eligible to participate in an annual bonus plan . We want you to be healthy, balanced, and feel secure. That's why you'll enjoy… more
- The Cigna Group (Bloomfield, CT)
- The Quality Review & Audit Senior Analyst ("Analyst") exhibits expertise in evaluating complex medical documentation for diagnosis code accuracy and compliance in ... This role is also anticipated to be eligible to participate in an annual bonus plan . We want you to be healthy, balanced, and feel secure. That's why you'll enjoy… more
- Sharp HealthCare (San Diego, CA)
- …networks. + Assists the Chief Medical Officer in designing and implementing corrective action plans to address issues and improve plan and network managed care ... and implemented into policies. + Participates in the retrospective review and analysis of Plan performance from...and updates as required in program descriptions, Annual Work Plans and policy and procedures to various plan… more
- Ventura County (Ventura, CA)
- …continuous County service, an additional 2% non-elective contribution will be made to the 401(k) plan . + Health Plans - Medical, Dental, and Vision Plans for ... dental, and/or vision insurance from a group of authorized plans . Employees may also participate in the Flexible Spending...based upon guidelines approved by the medical director and Plan Committee. + Provides or arranges timely review… more
- Consolidated Electrical Distributors (Irving, TX)
- Summary Job title: Remote Position - Quality Control\ Plan Review Specialist Job ID: 202526740001 Department: Greentech Design Services Location: TX-Irving ... Greentech Renewables' Design Services Team is looking for a Quality Control\ Plan Review Specialist to complete locally code-compliant plan -sets conforming to… more