- Commonwealth Care Alliance (Boston, MA)
- …claims adjudication, clinical coding reviews for claims, settlement, claims auditing and/or utilization review required + 7+ years experience with Optum Claims ... for One Year Term **_This position is available to remote employees residing in Massachusetts. Applicants residing in other...regulations. The role will also be responsible for timely review and research, as necessary on all new and… more
- Parexel (Hartford, CT)
- **Job Title:** Data Management Lead (Medical Affairs) - Oncology **Location:** Fully Remote (US based) Must be able to accommodate West Coast hours. **About Us:** At ... solutions, and ensure high-quality, compliant data. + Use surveillance tools to review data at an aggregate level, identifying patterns or anomalies to ensure… more
- University of Utah Health (Salt Lake City, UT)
- …services, medical advancement, and overall patient outcomes. **Responsibilities** + Review inpatient medical record documentation as it pertains to AHRQ, ... areas of high risk or opportunity for improvement. + Perform 100% pre-bill review for all encounters related to mortality and/or Patient Safety Indicator (PSI),… more
- NANA Regional Corporation (Huntsville, AL)
- …+ Aggregate, analyze, and report on monthly and quarterly financial forecasts. + Review and communicate labor utilization across the organization. + Primary POC ... PM with invoice collection. + Track contractual obligations and deliverables. + Review purchase request documentation for adherence and consistency. + Assist project… more
- Carnival Cruise Line (Miami, FL)
- …amazing Coordinator, Disbursements to fill this role, which is based in our remote office. This position is responsible for ensuring the accurate and timely ... processing, bank research, ad-hoc reporting, follow-up with bank personnel, and utilization of resources (people & systems) within corporate values, policies, and… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. ... anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in...order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician… more
- BrightSpring Health Services (Valdosta, GA)
- …report any discrepancies to BM. + Run monthly End of Month reports. + Run and review Utilization - Work all over utilized clients to prevent SVPs. + Time Detail ... report any changes to Business Office Manager. + Web Portal Patient Monthly Liability Review monthly - send any changes to Business Office Manager. + Verify weekly… more
- Bristol Myers Squibb (Princeton, NJ)
- …improved trial timelines, patient targeting, and payer negotiations, ensuring effective utilization of assets. **Behaviors for Success** + **Strategic Vision** : ... also be limited for the capability centers. Employees in remote -by-design or lab-based roles may be eligible for summer...the Job Title and Requisition number so we can review . Communications related to your application should not be… more
- Bristol Myers Squibb (Tampa, FL)
- …systems that aid benefits operations. + Help monitor and analyze benefit utilization trends to identify areas for improvement. + Participate in assigned ... also be limited for the capability centers. Employees in remote -by-design or lab-based roles may be eligible for summer...the Job Title and Requisition number so we can review . Communications related to your application should not be… more
- Banner Health (CA)
- …benefits, health and dental plan inquiries, and services of staff such as utilization review , prior authorization, billing and contract management. 6. Services ... and extend our innovation to employment settings by including remote and hybrid opportunities. As a **Service Center Representative**...Center Representative** , you will be working in a remote setting. **Shifts will be 3-12s varied, days or… more