- HCA Healthcare (Manchester, NH)
- …or ongoing professional practice evaluations (FPPE/OPPE), performance improvement, utilization patterns, peer review, or other performance information. Facilitate ... Patient Safety Work Product (PSWP). **Risk Management** Coordinate with the risk manager to review and evaluate an applicant's claims history and National… more
- HCA Healthcare (Manchester, NH)
- …or ongoing professional practice evaluations (FPPE/OPPE), performance improvement, utilization patterns, peer review, or other performance information. Facilitate ... Product (PSWP). 7. Risk Management Coordinate with the risk manager to review and evaluate an applicant's claims history...process in accordance with the facility's fair hearing and appeals policy as well as legal and regulatory requirements.… more
- Elevance Health (Tucson, AZ)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
- Elevance Health (Grand Prairie, TX)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
- Centene Corporation (Olympia, WA)
- …ensure continuity of care and improved member outcomes. + Experience as a Utilization Management (UM) Specialist, Appeals Coordinator, or Care Coordinator + ... or resources, as appropriate + May provide education to care manager and/or members and their families/caregivers on procedures, healthcare provider instructions,… more
- Elevance Health (Costa Mesa, CA)
- …Medical Director** **Carelon Medical Benefits Management** **Radiology Benefit Management/ Utilization Review** **Virtual** : This role enables associates to ... for services requested. + Makes medical necessity determinations for grievance and appeals appropriate for their specialty. + Ensures consistent use of medical… more
- Elevance Health (Mason, OH)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more
- Elevance Health (Waukesha, WI)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager , associates are required to work at an Elevance Health location at least… more
- The Cigna Group (Morristown, NJ)
- …terminology, specialty injectable medications, Cigna Coverage Review Department (CCRD), appeals , and/or utilization management + Familiarity with project ... Advisor Role Summary:** Reporting to the Gene and ACT Clinical Program Senior Manager , the Program Advisor plays a key role in ensuring strategic, operational, and… more
- Elevance Health (Pembroke Pines, FL)
- …of all prior authorization determinations. + Provides resolution to grievances and appeals issues. + Responds to inquiries from physicians, sales team, and members ... formulary and prescription benefits. + Generates reports relating to rebates, physician utilization , Beers Criteria, Reliance members, and other ad hoc reports. +… more