• Manager - Utilization Review & Denials…

    Beth Israel Lahey Health (Plymouth, MA)
    …you're making a difference in people's lives.** Full Time **Job Description:** **Utilization Review & Denials management manager - Full Time** **Who We Are:** At ... proud to be a trusted healthcare provider, offering personalized, high- quality care to the South Shore of Massachusetts. As...Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you will:** + Directs… more
    Beth Israel Lahey Health (07/29/25)
    - Related Jobs

  • Utilization Review Intake RN Behavioral…

    AdventHealth (Glendale Heights, IL)
    …assure resolution of pending denials, which have been referred to the physician for peer -to- peer review with the Medical Director of the insurance carrier. ... Day One for FT/PT positions + Student Loan Repayment Program for FT/PT positions + Career Development + Whole...to the Physician Advisor or designated leader for additional review as determined by department standards. Additionally, the UM… more
    AdventHealth (06/13/25)
    - Related Jobs

  • Professional CCG Paramedic, East

    UPMC (Thomasville, PA)
    …and/or over the counter medicine use. + Participates constructively in the peer - review driven quality improvement program . + Reflects a positive attitude ... to all employee health requirements, including maximum weight, hearing conservation program , and required medical screenings. Reports injuries and completes the… more
    UPMC (07/08/25)
    - Related Jobs

  • Professional CCG Paramedic

    UPMC (York, PA)
    …and/or over the counter medicine use. + Participates constructively in the peer - review driven quality improvement program . + Reflects a positive attitude ... to all employee health requirements, including maximum weight, hearing conservation program , and required medical screenings. Reports injuries and completes the… more
    UPMC (06/26/25)
    - Related Jobs

  • Professional CCG Nurse, East

    UPMC (Thomasville, PA)
    …confidentiality and dignity at all times. + Participates constructively in the peer - review driven quality improvement program . + Responds promptly and ... assigned. Must be able to successfully complete the prescribed orientation program , including classroom, clinical rotations, educational competencies, and on the job… more
    UPMC (07/17/25)
    - Related Jobs

  • Professional CCG/Flight Nurse, East - Thomasville.

    UPMC (Thomasville, PA)
    …demographic, medical necessity, and billing information. Participates constructively in the peer - review -driven quality improvement program . Adheres ... to all employee health requirements, including maximum weight, hearing conservation program , and required medical screenings. Reports injuries and completes the… more
    UPMC (07/10/25)
    - Related Jobs

  • Senior Director Development - Foundation - Hybrid…

    Houston Methodist (Houston, TX)
    …campaigns. The Sr. Director position responsibilities include ensuring quality , productivity, functional excellence and efficiency to accomplish strategic ... engages stakeholders in the development and achievement of strategic initiatives. ** QUALITY /SAFETY ESSENTIAL FUNCTIONS** + Ensures a safe and effective working… more
    Houston Methodist (05/20/25)
    - Related Jobs

  • Utilization Review Medical Director

    Commonwealth Care Alliance (Boston, MA)
    …for performing daily medical reviews, appeals as appropriate, correspondence regarding review determinations and physician peer review activities. ... the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will...a key role in helping our organization provide high quality , equitable care to our rapidly growing membership. The… more
    Commonwealth Care Alliance (06/27/25)
    - Related Jobs

  • Risk Mgr./RN Quality Program…

    LifePoint Health (Los Alamos, NM)
    …abstraction for Core Measures, external collaboratives, and other QI programs. The Quality Program Specialist collaborates with leaders, process owners, and ... measure impact/improvement. Supports medical staff performance improvement initiatives, performs chart review studies for peer review processes.… more
    LifePoint Health (06/17/25)
    - Related Jobs

  • Sr. EMT - Stat MedEvac

    UPMC (Pittsburgh, PA)
    …program , and required medical screenings. + Participates constructively in the peer - review driven quality improvement program . + Performs all assigned ... assigned. Must be able to successfully complete the prescribed orientation program , including classroom, clinical rotations, educational competencies, and on the job… more
    UPMC (06/18/25)
    - Related Jobs