- Fallon Health (Worcester, MA)
- …and clinical functions related to outpatient and inpatient, utilization management operations, including but not limited to prior authorization, concurrent ... + Recommends and implements innovative process improvements for the prior authorization and utilization management ...cost of care opportunities related to Utilization Management . + Works with VP/ Medical Director … more
- Evolent (Hartford, CT)
- …LMSWs, LCSW, and LPCs, Clinical Reviewers. Opportunities to work collaboratively with other Utilization Management Leaders including our Director may also be ... the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for… more
- Humana (Hartford, CT)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... Medical Director , depending on the line of business. The Medical Director conducts Utilization Management or clinical validation of the care received by… more
- Evolent (Hartford, CT)
- …Clinical Reviewer, Interventional Pain Management , you will be a key member of the utilization management team. We can offer you a meaningful way to make a ... + On a requested basis, may function as Medical Director for selecting health plans or regions, assuming overall...selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with… more
- Evolent (Hartford, CT)
- …impact on patient care in a non-clinical setting? Join our Utilization Management team as a Field Medical Director , Cardiovascular Specialist and use your ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Hartford, CT)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... , depending on size of region or line of business. The Medical Director conducts Utilization Management of the care received by members in an assigned… more
- Evolent (Hartford, CT)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... culture. **What You'll Be Doing:** As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- Evolent (Hartford, CT)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... **What You'll Be Doing:** As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a… more
- Humana (Hartford, CT)
- …skills, with prior experience participating in teams focusing on quality management , utilization management , case management , discharge planning ... Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a… more
- Evolent (Hartford, CT)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. . ... the culture. **What You'll Be Doing:** As a Field Medical Director , Oncology, you will be a key member of the utilization management team. We can offer you a… more
- Humana (Hartford, CT)
- …+ Demonstrate adaptability and willingness to learn evolving workflows, tools, and utilization management practices **Work Schedule Monday - Friday w/standard ... hospitals/ Integrated Delivery Systems, health insurance, or other healthcare providers. + Utilization management experience in a medical management review… more
- Humana (Hartford, CT)
- …with prior experience participating in teams focusing on quality management , utilization management , or similar activities **Preferred Qualifications:** ... community and help us put health first** The Medical Director relies on broad clinical expertise to review Medicare...Integrated Delivery Systems, health insurance, or clinical group practice management + Utilization management experience… more
- Evolent (Hartford, CT)
- …Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. + ... Radiology you will be a key member of the utilization management team. We can offer you...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- The Cigna Group (Bloomfield, CT)
- Role Title: Director , Product Management - Customer Data Platform As a Product Director in Evernorth's Digital team, you will be responsible for helping to ... Senior Director and includes managing all aspects of product management including strategy & roadmap development, research & analysis, and platform execution,… more
- The Cigna Group (Bloomfield, CT)
- …external customers. He/she will serve as a clinical educator and consultant to utilization management , case management , network, contracting, pharmacy, and ... be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management , utilization review and case management in a managed care… more
- RTX Corporation (Farmington, CT)
- …businesses, is headquartered in Arlington, VA. **Position Overview:** The Associate Director , Hosting Product Manager is responsible for shaping the long-term ... vision, product management direction, and transformation agenda for hosting services. This...operational efficiencies, reduce deployment times, improvements in hosting power utilization , and service placement optimizations. **What You Will Do:**… more
- Evolent (Hartford, CT)
- …medical review roles that emphasize volume throughput, this position integrates utilization management with collaborative engagement and innovation. **Core ... for individuals facing cancer. As a Performance Suite Medical Director in Medical Oncology, you will play a pivotal...I-9 verification, and may be subject to drug screening prior to employment. The use of artificial intelligence tools… more
- Kyndryl (Hartford, CT)
- …ultimately supporting execution. Partners will be focused on financial impact, utilization and contribution, client impact and leadership. **Contribute to Profitable ... development; Secure client references **Operational Excellence:** + Achieve individual and team utilization targets + Lead the design of complex engagements and take… more
- Fallon Health (Worcester, MA)
- …call center setting or physician's office; knowledge of managed care and/or utilization management strategies advisable + Excellent writing skills with ... customer expectations. The FH Authorization Coordinator serves to administer the FH prior authorization process as outlined in the Plan Member Handbook/Evidence of… more
- Evolent (Hartford, CT)
- …The Clinical Review Nurse is responsible for performing precertification and prior approvals. Tasks are performed within the **RN/LVN/LPN** scope of practice, ... under the Medical Director 's direction, using independent nursing judgement and decision-making, physician-developed medical policies, and clinical decision-making… more