- Stryker (Memphis, TN)
- …software architecture aligned with regulatory requirements. + Drive development and utilization of tools and systems that enhance product and process performance. ... Agile methodology. + Direct experience in vulnerability management and defect review . + One or more active, industry-recognized cybersecurity certifications. +… more
- University of Southern California (Los Angeles, CA)
- …variances to target metrics * Identify and develop process improvement initiatives * Review and Monitoring of daily departmental analytics to ensure high level of ... efficiency in utilization of CLM system through both monthly and daily data reporting * Manage intake, assignment, process flow, and reporting/dashboarding *… more
- CommonSpirit Health (Englewood, CO)
- **Job Summary and Responsibilities** **This is a remote position** As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews ... objectives for providing quality patient care, to assure effective and efficient utilization of health care services. The PA communicates remotely with case and… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …characteristic. Blue Cross and Blue Shield of Minnesota Position Title: Peer Review Coordinator Location: Hybrid | Eagan, Minnesota Career Area: Health Services ... a wide variety of services related to BCBSMN peer review services. The position works closely with the Medical...The position works closely with the Medical Director of Utilization Management and the Medical Director of Behavioral Health… more
- UPMC (Pittsburgh, PA)
- UPMC Health Plan is looking for Pharmacy Clinical Review Specialist I positions in the Pharmacy Services department. This is a full time position working Monday ... through Friday 11:30am to 8:00pm and weekend rotations. The Clinical Review Specialist will oversee administrative and system processes that relate to pharmacy prior… more
- Molina Healthcare (Tacoma, WA)
- …a (RN) Registered Nurse who must hold a compact license. This is a Remote position, home office with internet connectivity of high speed required Work Schedule ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Louisville, KY)
- …who must be licensed in KY or have a compact RN license. The Care Review Clinician Inpatient Review BH will provide prior authorization for outpatient and ... weekend day required (Saturday, Sunday (either one or both)) This is a Remote position, home office with internet connectivity of high speed required. JOB… more
- Gilead Sciences, Inc. (Foster City, CA)
- …change over time, our initial need is for an expert in Material Review platforms (Veeva MedInquiry, VeevaVault, MedDocs, etc). Responsibilities include but are not ... + Hands on experience administering and deploying platforms for Material Review (Veeva MedInquiry, VeevaVault, MedDocs) preferred. + Additional certifications in… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …difference, join us. The Impact You Will Have This job implements effective utilization management strategies including: review of appropriateness of pre and ... of Minnesota Position Title: Care Manager PreService & Retrospective - Autism Location: Remote Career Area: Health Services About Blue Cross and Blue Shield of… more
- Excellus BlueCross BlueShield (Buffalo, NY)
- … management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review , quality ... of physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization … more