- Insight Global (Brookfield, WI)
- …technology implementations. * Deep knowledge of medical cost containment strategies (bill review , utilization review , provider networks, nurse case ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- Molina Healthcare (NM)
- …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
- 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
- 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
- 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
- Trinity Health (Columbus, OH)
- …**Shift:** Day Shift **Description:** The Clinical Documentation Specialists will concurrently review medical records and assist physicians in removing the barriers ... Minimum of 5 years acute care medical or surgical experience required; Utilization /Case Management, managed care, or Clinical Documentation and experience in ICD-10… more
- Insight Global (New York, NY)
- …metrics to evaluate team and operational success. Continuously evaluate resource utilization and suggest improvements for better outcomes. Supervise and coordinate ... we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/. Skills and… more
- The Cigna Group (Raleigh, NC)
- …model monitoring / maintenance using a broad range of medical, prescription drug, utilization management, and third-party data. In this role you will work closely ... practices and writes clean, documented, and well-structured code + Ability to peer review + Champions a culture of documentation and logging + Ability to own… more
- Stanford Health Care (Palo Alto, CA)
- …+ ICU/ED and Academic Medical Center experience preferred. + Case management, utilization review and/or direct provider interaction experience, preferred. + ... Experience in public speaking, as well as educational content creation and delivery of formal multidisciplinary education, preferred. + Experience with Vizient, Premier, Elixhauser and other risk adjustment methodologies, highly preferred. **Required… more
- The Cigna Group (Bloomfield, CT)
- …clients and preserve earnings. + Participate in client meetings and presentations to review client performance and sell in the suite of pharmacy management programs ... the medical sales teams. + Support detailed ad-hoc analysis of pharmacy claims utilization in order to provide clients with proactive consultation, as well as manage… more