- Humana (Montgomery, AL)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- Amazon (TX)
- …delivery and improve healthcare accessibility. You'll oversee the operations for the National Remote Primary Care (RPC) team managing remote providers across the ... monitor quality and customer experience, provide gap analysis and business review documents while working cross functionally throughout the organization to lead… more
- Kemper (Chicago, IL)
- Location(s) Jacksonville, Florida, Remote -AL, Remote -CT, Remote -FL, Remote -GA, Remote -IL, Remote -IN, Remote -OH, Remote -PA, Remote -WI ... complex technical problems and issues with assigned applications and work processes. + Review and recommend test plans for impacted areas and end to end test… more
- Integra Partners (Troy, MI)
- The Utilization Management (UM) Coordinator Supervisor oversees the day-to-day operations and performance of the UM Coordinator team. This position ensures that all ... and NCQA standards. The Supervisor provides daily coaching, quality review , and workflow oversight while fostering collaboration, accountability, and teamwork… more
- Bristol Myers Squibb (Devens, MA)
- …to support operations and identify opportunities to improve overall resource utilization and capacity. + Create and maintain capacity models, simulation models, ... connected with the process, where value is created. + Analyzes work force utilization , facility layout, and operational data such as production costs, process flow,… more
- University of Michigan (Ann Arbor, MI)
- …and expense projections; establish controls to maintain budget oversight; review business transactions for compliance with relevant policies and regulations ... for professional development; approve job descriptions for non-academic positions; review positions for appropriate classification and compensation level; provide… more
- Commonwealth Care Alliance (Boston, MA)
- …understanding of CCA's mission, value-based approach, and expectations for quality, utilization , and member experience. * Address provider inquiries related to care ... coordination, utilization management, and program participation, collaborating with internal teams...BH and Health Home providers. * Participate in case review meetings and rounds as needed to enhance coordination… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent assesses ... for the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review . Ensures all accurate… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …and performance monitoring, oversees all Workers' Compensation (WC) Case Management and Utilization Review (UR) Programs. + Collaborates with the Chief Medical ... for the Casualty and Clinical Services departments which in turn includes Utilization Management, Case Management and Population Health divisions. The position can… more
- AECOM (Denver, CO)
- …to I&G Director for annual budgets and business planning, staff utilization , department resource needs (hardware/software needs, strategic investments) and other ... future resource and staff needs to optimize the department staff utilization , including incorporation of value Engineering Centers in project staff planning… more