- Elevance Health (Walnut Creek, CA)
- …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 ... not required for posting. + Works independently with oversight from immediate manager . + May be responsible for an entire clinical program and/or independently… more
- Elevance Health (Denver, CO)
- …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 ... cost of care opportunities. Works independently with oversight from immediate manager . May be responsible for an entire clinical program and/or independently… more
- Elevance Health (Durham, NC)
- …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 ... law._** The **Clinical Pharmacist** is responsible for managing the selection and utilization of pharmaceuticals and supports core clinical programs such as DUR, DIS… more
- Houston Methodist (Sugar Land, TX)
- …care benefits + Supports and assists with concurrent insurance denials and appeals process, transmission of utilization reviews to insurance companies, ... the case management and social work department to facilitate efficient utilization of resources and discharge planning including referrals management, communication… more
- Elevance Health (Morristown, NJ)
- …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 ... of managed care experience preferred. + Consulting experience preferred. + Utilization management experience preferred. + Master's Degree preferred. (MBA, MPH, etc.)… more
- Elevance Health (Neillsville, WI)
- …issues impacting provider satisfaction, researches and resolves complex provider issues and appeals for prompt resolution. **How you will make an impact:** + ... on such issues as administrative and medical policy, reimbursement and provider utilization patterns. + Conducts provider site visits and technical assistance to… more
- Elevance Health (Denver, CO)
- …+ Researches, analyzes, and coordinates prompt resolution to provider issues and appeals through direct contact with providers and internal matrixed partners. + ... on such issues as administrative and medical policy, reimbursement, and provider utilization patterns. + Conducts routine outreach to support the understanding of… more
- Elevance Health (Indianapolis, IN)
- …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 ... and overseeing clinical/non-clinical activities. Will also be responsible for utilization review/management. May be responsible for developing and implementing… more
- US Tech Solutions (Columbia, SC)
- …to this and will be reviewed with Management + Skill sets: Appeals and reconsideration experience, Utilization management experience, Prior experience working ... Identifies and makes referrals to appropriate staff (Medical Director, Case Manager , Preventive Services, Subrogation, Quality of care Referrals, etc.). +… more
- Humana (Indianapolis, IN)
- …implementation of the Quality Management (QM) program; and work closely with the Utilization Management (UM) of services and associated appeals related to adults ... strategic management of behavioral and physical health services, including Utilization Management (UM), Quality Improvement, and value-based payment programs. The… more
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