- Molina Healthcare (Kenosha, WI)
- …team and key stakeholder meetings (PowerPoint) * Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... stakeholders requiring decision support. * Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more
- Dragonfly Health (TN)
- …adherence, safety, and cost-effectiveness. + Educate internal teams on formulary management, utilization review , and pharmacy policy updates. **What we look ... **What you will do** + Provide clinical review and consultation on medication requests, prior authorizations,… more
- Bowman (Herndon, VA)
- … Review project close-out documentation (O&M Manuals). + Maintain utilization targets. + Communicate effectively with client, internal project team, ... of principles and practices in broad areas of assignments and related fields. Review work produced by staff for quality assurance. **At the Operational and Company… more
- Molina Healthcare (New York, NY)
- …team and key stakeholder meetings (PowerPoint) + Coordinates and provides peer review of our quarterly national contract performance analysis by team members to ... stakeholders requiring decision support. + Evaluates, writes, and presents healthcare utilization and cost containment reports and makes recommendations based on… more
- Molina Healthcare (Austin, TX)
- …Reforecast according to Corporate guidelines. + Collaborate with Actuarial staff to review IBNR estimates and rate adequacy studies. + Analyze results to identify ... operational management to identify saving opportunities and areas of medical utilization concerns. + Provide support to financial closing process regarding estimated… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more
- Ryder System (Sacramento, CA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : **Summary** The ... to get things done regardless of obstacles + Optimized utilization of resources to provide a delightful and consistent...apply using the internal application process. _Job Seekers can review the Job Applicant Privacy Policy by clicking here… more
- CareFirst (Baltimore, MD)
- …by handling non-clinical tasks related to preauthorization functions, inpatient care, utilization review , care coordination and/or quality of care, enabling ... authorization requests for initial determination and/or triages for clinical review and resolution. Screens, and/or prioritizes members using targeted intervention… more
- Ryder System (Alpharetta, GA)
- _Job Seekers can review the Job Applicant Privacy Policy by clicking here (http://ryder.com/job-applicant-privacy-policy) ._ **Job Description** : The Card ... reporting, and policy compliance + Prepares management reports on program utilization , spending trends, and compliance metrics for both countries + Implements… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more