- Sharecare (Albany, NY)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited to ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management intake or...Physical Therapy Assistant + Nursing Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide +… more
- Clark County, NV (Las Vegas, NV)
- …resource management system tables; develops and analyzes user requirements for utilization of the appropriate system. + Prepares and maintains customer ... generated based on the applicant's response to each item in the assessment, score appeals will not be allowed for this recruitment. + I have read and understand… more
- Elevance Health (Lima, OH)
- …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 ... May be responsible for developing and implementing programs to improve quality, utilization trends, and member outcomes. May provide clinical consultation and serve… more
- Molina Healthcare (Green Bay, WI)
- …oversight and clinical leadership for health plan and/or market specific utilization management and care management behavioral health programs and chemical ... working closely with regional medical directors to standardize behavioral health utilization management policies and procedures to improve quality outcomes and… more
- Cedars-Sinai (Beverly Hills, CA)
- …fuels innovation. **A Little More About What You Will be Doing** The Case Manager is responsible for the case management of patient while hospitalized and upon ... with the Inpatient Specialty Program (ISP) hospitalists, the Case Manager will assist patients from the time they are...of care. Use evidence based review guidelines to conduct utilization review as is appropriate to match the payor… more
- State of Colorado (Denver, CO)
- …participants + Knowledge of evaluation frameworks and approaches ( utilization -focused evaluation, developmental evaluation, equitable evaluation, Stepwise, REACT, ... Procedures, 4 CCR 801, for more information about the appeals process. The State Personnel Board Rules and Personnel...be invited to schedule an interview with the hiring manager . E-Verify: CDPHE uses e-Verify, an Internet-based system, to… more
- State of Colorado (Denver, CO)
- …unit standards; + Promote collaborative multi-disciplinary services and resource utilization to increase offender success in geographically diverse parole regions. ... establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- State of Colorado (Chaffee County, CO)
- …sites. These assignments may require a great deal of walking and hiking, utilization of land navigation and orienteering skills and operating vehicles off highway in ... establish an eligible list for referral to the hiring manager for final consideration. Use of artificial intelligence (AI)...of the department's action. For more information about the appeals process, the official appeal form, and how to… more
- Beth Israel Lahey Health (Cambridge, MA)
- …action and offer options. + If you're unable to resolve a situation, find a manager who can. **9. Protect confidentiality and privacy:** It's a matter of respect and ... REQUIRED** 1. RN with experience in risk management, quality assessment, or utilization management. 2. Strong spreadsheet, database, and word processing skills in… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and serve as a liaison and patient advocate between Dana ... overturned. + Appropriately escalates complex cases to Drug Authorization Supervisor or Manager of Prior Authorizations. + Monitors email communication to the Drug… more
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