- Battelle Memorial Institute (Columbus, OH)
- …define and resolve complex issues. + Conducts quality control and quality assurance review of program documents prior to submission to management. + Contributes to ... regulations. + Must have DoD Secret security clearance. Location: Remote **Preferred Qualifications** + Strength in communications and international relations.… more
- Sedgwick (Shreveport, LA)
- …state and physician filings and decisions on appropriate treatments recommended by utilization review . + Maintains professional client relationships. + Performs ... Compensation | Jurisdiction: Multi State | TX/FL/OK/LA License preferred ( Remote /Hybrid) Are you looking for an opportunity to join...of this radius will be considered for a fully remote arrangement. **PRIMARY PURPOSE OF THE ROLE:** We are… more
- Trinity Health (Livonia, MI)
- …Type:** Full time **Shift:** Day Shift **Description:** **POSITION PURPOSE** Work Remote Position At the direction of the Regional Manager, Clinical Documentation ... to enhance clinical and coding skill sets and optimal utilization of the 3M CDI software. Responsible for scheduling...direct reports perform clinical validation as part of the review process and remain current on CDI strategies. Maintains… more
- SitusAMC (Austin, TX)
- …and address potential resource constraints or bottlenecks. + Report on resource utilization and manage capacity for the team. + **Project Planning and Coordination** ... (PPM) tool is a plus. + Experience working remotely and household setup conducive to remote work \#LI- AS1 #LI- Remote Note: This job description is not intended… more
- Optiv (Albuquerque, NM)
- _This position will be fully remote and can be hired anywhere in the continental US_ The Practice Manager is a key leadership role within our Services consulting ... documented, up to date, and consistently applied across all projects + Review and approve project deliverables for accuracy, completeness, and alignment with… more
- Molina Healthcare (Idaho Falls, ID)
- Molina Healthcare is hiring for remote Certified Pharmacy Technicians. These roles will be in our Prior Authorization department. You will review prior auth ... member care. **Essential Job Duties** + Performs initial receipt and review of non-formulary or prior authorization requests against pharmacy plan approved… more
- Boston College (Chestnut Hill, MA)
- …of $3.9 billion. **Job Description** **Please note: This position is not fully remote .** (Senior) Compensation & HR Data Analyst The Compensation & HR Data Analyst ... actions and employment offers. + Assist in the annual merit review program, including data validation, reporting, trend analysis, and effectiveness evaluation.… more
- Sharp HealthCare (San Diego, CA)
- …in a managed care setting. **Other Qualification Requirements** + Utilization , Case Management, or Quality Management certification preferred. **Essential ... and compliance parameters.Implement and maintain the reporting systems for operational and utilization outcome indicators as it relates to the daily ACM operations.… more
- NexTec Group (TX)
- …(with minimal guidance and oversight) within alignment of SOW, Business Process Review (BPR) documentation, and NexTec methodology. + Maintaining 70 percent or ... higher utilization on an average annual basis. + Maintaining appropriate...with customers. + Following NexTec implementation methodologies. + Achieving utilization targets while achieving high customer satisfaction. Education and… more
- Molina Healthcare (Columbus, GA)
- …requestors to ensure appropriate creation of reports and analyses. Uses peer-to-peer review process and end-user consultation to reduce report writing errors and ... and other statistical methodologies to predict future trends in cost, utilization and performance. Provide executive summary of findings to requestors. +… more