- Actalent (Chattanooga, TN)
- …various activities associated with coverage reviews and appeals including the review of medication related prior authorizations, pharmacy appeals, and member ... grievances focused on medications. - Performs prospective and retrospective coverage reviews and appeals per State and Federal regulations - Responds to prescriber, pharmacy provider, member appeals, grievances and complaints related to the provision of… more
- APTIM (Santa Fe, NM)
- **Job Overview:** The Team Lead -- Claims Review is responsible for supervising a multidisciplinary team of claims reviewers, estimators, and support personnel to ... ensure timely, accurate, and compliant claims processing in alignment with federal regulations and program requirements. This role serves as the primary point of escalation and quality assurance for assigned claims, supporting continuous training, technical… more
- WestCare Foundation (Henderson, NV)
- …and/or Bachelors or Masters level CADC/LADC with 2 years utilization review experience, preferred experience working with individuals with psychiatric or substance ... use disorder Experience and Competencies: + Proven experience in conceptualizing a case and creating a clinical impression to present to all involved and approved parties, including managed care representatives + Knowledge of CPT, ICD 9 & ICD 10 coding, ASAM,… more
- Grant Thornton (Charlotte, NC)
- As a Regulatory & Practice Review Seasonal Senior Manager you'll support audit teams for regulatory inspection with all with the resources, environment, and support ... to help you excel. Your day-to-day may include: + Supporting audit teams that are selected for regulatory inspection + Communicating and interaction with the firm's regulators + Conducting internal inspections of issuer and non-issuer audits + Interacting with… more
- Lockheed Martin (Palmdale, CA)
- **Description:** Palmdale, CA based assignment managing approx\. 20\-25 Material Review engineers\. Manager will be assigned the west coast segment of the MRB teams ... that includes F\-35 edge production, F\-22 Field component repair \(Palmdale\), F\-35 Flight Test \(EAFB,PAX River\) and U2 Periodic Depot Maintenance \(Palmdale - Site 2\)\. Direct reports support the dispositioning of non\-conforming material on the F\-35… more
- Molina Healthcare (Spokane, WA)
- …experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines. **Preferred ... License, Certification, Association** Active, unrestricted Utilization Management Certification (CPHM). **MULTI STATE / COMPACT LICENSURE** **Individual state licensures which are not part of the compact states are required for: CA, NV, IL, and MI** **WORK… more
- San Diego Community College District (San Diego, CA)
- …Until Filled No Classification Title INTERDISCIPLINARY BASIC SKILLS-Math Review |CBEST: Adjunct/Substitute Instructor POOL (non-credit) Working Title Adjunct Faculty ... Recruitment Limits Location District Wide Pay Information At the time that an offer of assignment is made, proper salary placement is contingent upon receipt of OFFICIAL (sealed) transcripts and Verifications of Previous Work Experience (if applicable).… more
- City of New York (New York, NY)
- …(1) Admin Staff Analyst NM III to function as a(n) Executive Director, Financial Review & Claims Processing who will: - Manage, plan and develop the operational ... activities of DFRP, ICP and SNAP-CR Directors as they administer their specific program areas which are responsible for initiating adverse actions on cash assistance cases due to information obtained via computer matches, sanctioning individuals who fail to… more
- City of New York (New York, NY)
- …and knowledgeable experts. The DOC seeks to recruit a Director of Internal Audit Review unit. The selected candidate will be responsible but not limited to the ... following; -Directing and administering the auditing activities of an agency based on identified risk assessments; -Working with the Auditing division or other organizational unit with an auditing, accounting, or financial function, including execution of… more
- Holzer Health System (Gallipolis, OH)
- Perform clinical audits and review data to improve quality standards. Provide administrative support such as data entry, data checking, maintaining data bases, ... documentation and record keeping. The focus of this role will be to optimize and report on data gathered from quality reports and close gaps in care as well as perform any other duties as assigned. Education, Work Experience and Licensure: * Two-Three years… more