- Molina Healthcare (OH)
- …performance of one or more of the following activities: care review , care management, utilization management (prior authorizations, inpatient/outpatient medical ... in some or all of the following functions: care management, utilization management, behavioral health, care transitions, long-term services and supports (LTSS),… more
- World Insurance Associates, LLC. (Miami, FL)
- … review analysis + Renewal rate and funding initial projections/modeling + Claims utilization review + Rate and contribution modeling + Benchmarking studies + ... self-funded arrangements. You'll prepare financial deliverables, model renewals, evaluate utilization trends, and support client decision-making with data-driven insights.… more
- Martin's Point Health Care (Portland, ME)
- …Summary The Medical Director (MD) provides clinical leadership and direction to the utilization & care management functions of Martin's Point's Health Plans. The MD ... Health Plan members. + Assists in the construction of the annual Utilization Management, Care Management, and Disease Management Program Descriptions and works to… more
- UPMC (Pittsburgh, PA)
- …prescribing and utilization to identify potential clinical care issues; prepayment review of claims, and prepayment review of unlisted codes. Claims analysis ... services related to clinical guidelines, coding requirements, regulatory requirements, and resource utilization . This role also acts as a SME for the department in… more
- Mount Sinai Health System (New York, NY)
- …Description** **Director Medical Affairs Operations-Medical Staff Services -Full-Time -Days ( Remote )** _Our flexible remote opportunities offer an excellent ... opportunity for those who flourish in a remote environment to achieve improved work/life balance as well...all matters related to medical staff governance, credentialing, peer review and performance management; + In collaboration with the… more
- Optiv (Overland Park, KS)
- …right staff assignments are made in right timeframes. + Maximize utilization . + Increase visibility of availability. + Assess skills/certifications against pipeline, ... the identification and assignment of services team members and subcontractors. + Review schedule data proactively to maintain high degree of timelines, accuracy, and… more
- CVS Health (Topeka, KS)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Cordis (Miami Lakes, FL)
- …EMEA, and APAC) focusing on understanding, optimizing, and directing IT spend and asset utilization . This is a remote role within the continental US and will ... impact IT spend. + Conducting various forms of Cordis IT spend and utilization analysis supported by market data, internal and external benchmarks, and current… more
- ChenMed (Miami, FL)
- …experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $204,761 - $292,515 Salary **EMPLOYEE ... and Quality improvement in our developing area of Delegated Utilization Management. **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Clinical Appropriateness… more
- NexTec Group (TX)
- …must be located in the United States or Canada. This is a remote role. Objectives (Key Outcomes): + Complete assigned tasks independently and may collaborate ... within alignment of the Statement of Work, Business Process Review (BPR) documentation, and NexTec methodology. + Maintain at...and NexTec methodology. + Maintain at least 75 percent utilization on an average annual basis. + Maintain Acumatica… more