- Carnegie Mellon University (Pittsburgh, PA)
- …Provide analytical support and financial insight for audits, facilities projects, space utilization , grants management , and special projects. + Coordinate with ... + Coordinate with grant and contract accounting, including pre-award budget review , post-award expense tracking, effort reporting, and closeout. + Coordinate with… more
- Molina Healthcare (Mount Pleasant, SC)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary… more
- Penn Medicine (Philadelphia, PA)
- …hospice, community resources, transportation, and quality data collection and risk management referral. Responsibilities: + Utilization management ... DME, placements, hospice, community resources, transportationQuality data collection and risk management referralWorks with patient and family to assure provision of… more
- Centene Corporation (Austin, TX)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- MTC (Chaparral, NM)
- …+ Monitor all potential catastrophic illnesses. + Implement basic cost containment and utilization management for patient care and facility operations. + Comply ... + 401(k) Retirement Plan + Employee Assistance Program (EAP) Impact lives with Management & Training Corporation (MTC)! At the Otero County Prison Facility's Medical… more
- CVS Health (Annapolis, MD)
- …questions and recurring provider submission issues. + Collaborate with Utilization Management /Medical Management on authorization-related claims ... heart, each and every day. **Position Summary** The Manager of Claims Management is responsible for overseeing Medicaid claims operations, inventory management ,… more
- Geisinger (Shamokin, PA)
- …all Revenue Management teams and departments including Practice Consultants, Utilization Management and Care Management , Providers, Geisinger ... and out surgeries and outpatient clinical departments. + Follows Revenue Management policies and procedures regarding financial matters and payment arrangements. +… more
- Charter Care Health Partners (North Providence, RI)
- …progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management ; Continuum of Care ... recent experience with case management , patient navigation, case management , utilization review or discharge planning is strongly preferred. Must… more
- Charter Care Health Partners (North Providence, RI)
- …progress of a specific patient population. Performs functions related to Patient Advocacy; Utilization Review ; Resource Management ; Continuum of Care ... recent experience with case management , patient navigation, case management , utilization review or discharge planning is strongly preferred. Must… more
- CareFirst (Baltimore, MD)
- …of regulatory and accreditation requirements, understanding of appeals process and utilization management , and systems software used in processing appeals. ... of members for Commercial lines of business. Ensures quality management of the clinical appeal process to reduce the...with dynamic goals resulting in the full and fair review of appeals and designed to achieve corporate objectives… more