- US Tech Solutions (Atchison, KS)
- …advantage for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... Utilizes critical thinking and judgment to collaborate and inform the case management process, in order to facilitate appropriate healthcare outcomes for members by… more
- Travelers Insurance Company (Austin, TX)
- …skills **What is a Must Have?** + Licensed MD + 5 years clinical and utilization management experience + Certified by the American Board of Medical Specialties ... to keep Travelers at the leading edge of the P&C industry. Develop medical management strategies that help injured employees return to work as soon as medically… 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
- 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
- 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
- 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