- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Centene Corporation (Richmond, VA)
- …including a fresh perspective on workplace flexibility. **Position Purpose:** Directs the utilization management team to ensure the appropriate application of ... manages Utilization Operations specific to the daily operations of Utilization Management including timeliness, quality and performance outcomes, provider… more
- Humana (Richmond, VA)
- …Qualifications** + Bachelor of Science in Nursing. + Experience with case management , discharge planning or prior authorization . + Knowledge of Milliman ... us put health first** Humana is seeking a Prior Authorization RN to join the Wisconsin Medicaid Market (iCare)...and subacute activity daily for outcomes related to readmission, utilization , quality of care and provider performance in compliance… more
- Elevance Health (Norfolk, VA)
- …experience, which would provide an equivalent background. **Preferred Qualifications:** + Utilization management experience preferred. For candidates working in ... services to drive affordability and improve member outcomes. The **Medical Director Associate- CarelonRx** supports pharmacy prior authorization reviews to… more
- The Goodyear Tire & Rubber Company (Danville, VA)
- Reporting to the Director Americas Manufacturing, Commercial & Aero, the Manufacturing Director will plan, organize and direct the plant operations within a ... large tire manufacturing environment (1000 associates) in Danville, VA. As Manufacturing Director this individual will be expected to deliver results that meet… more
- CVS Health (Richmond, VA)
- …members across Aetna. **Expectations and Responsibilities:** * Serve as the principal utilization management reviewer for cases related to Applied Behavior ... Director , Aetna Medicaid, this role is responsible for utilization , quality, and fraud, waste, and abuse reviews for...Attend and actively participate in clinical meetings with care management and utilization management teams,… more
- TekSynap (Radford, VA)
- …components including XenApp, NetScaler Gateway, Citrix Storefront, and Citrix Director . + Execute system hardware and software implementations; maintain detailed ... performance and security posture. + Track system performance metrics, generate utilization reports, and identify areas requiring corrective action. + Recommend and… more
- Humana (Richmond, VA)
- …corporate communications to be shared with senior leadership. + Supports trend management by conducting analysis of drug spend, utilization , and/or approval ... ensuring compliance with programmatic requirements, such as claims processing, prior authorization , formulary management and clinical programming + Represents… more
- Air National Guard Units (Langley AFB, VA)
- …guidelines, policies, and regulations. Provides plans for an efficient resource management program and maximum support of service delivery to include resource ... issues, trends, needs, program priorities, and program effectiveness through utilization of appropriate research methods and resources. Analyzes ongoing family… more