- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Senior Project Manager manages all aspects of a project, from start to finish, so that it ... on continuously improving consumer experiences **Preferred Qualifications** + Project Management Certification + Experience in business consulting + Experience in… more
- CVS Health (Jackson, MS)
- …for Aetna. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management and ... including after-hours consultation as needed. + Leads all major clinical, population health management , and quality improvement components of the aligned plan.… more
- Evolent Health (Jackson, MS)
- …Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the SVP, CCO and/or ... department, you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Medical Directors, and health … more
- CVS Health (Jackson, MS)
- … in support of Key Clients as assigned. The Medical Director transacts Utilization Management UM activities (prior authorization and appeals) and responds to ... Bring your heart to CVS Health . Every one of us at CVS ...commercial client program support. Will share in reviews of utilization management (PA) criteria and clinical policy… more
- Evolent Health (Jackson, MS)
- …As a Behavioral Health Field Medical Director will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Initial Clinical Reviewers. **What you'll be doing:** + Supports pre-admission review, utilization management , and concurrent and retrospective review process. +… more
- Evolent Health (Jackson, MS)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Reviewer you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Jackson, MS)
- …Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services such ... Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management … more
- Humana (Jackson, MS)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), ...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Sharecare, Inc. (Jackson, MS)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... meets compliance timelines. **This is a full-time work from home opportunity. Candidates may live anywhere in the US...health insurance, other healthcare providers, clinical group practice management . + Utilization management experience… more
- Evolent Health (Jackson, MS)
- …Codes, CPT Codes, RVUs, bundled payments, including value-based care and utilization management - **Required.** + Experience in developing regulatory reporting ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...trends, medical economic KPIs (eg PMPM), and drilling into cost/ utilization patterns to identify cost/use drivers - **Required** +… more
- Evolent Health (Jackson, MS)
- …story of value contributed to the partnership. + Strong knowledge of health plan operations, care/ utilization management , claims processing, value-based ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...organizational objectives. **What You Will Be Doing:** **Account/ Relations Management ** - provide corporate, executive and overall account … more
- Humana (Jackson, MS)
- …hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical management review ... part of our caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , and acute… more
- Evolent Health (Jackson, MS)
- … and process improvement practices and methodologies + Basic knowledge of health care management (CPT Codes, Medicare/Medicaid + Strong facilitation and ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...Will Be Doing:** + Support team responsibilities and project management activities as assigned + Manage day-to-day operational aspects… more
- Evolent Health (Jackson, MS)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion… more
- CVS Health (Jackson, MS)
- …consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management . In this role you ... Bring your heart to CVS Health . Every one of us at CVS ...care resources. **This is a remote based (work at home ) based anywhere in the US.** The Medical Director… more
- CVS Health (Jackson, MS)
- …consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management . In this role you ... Bring your heart to CVS Health . Every one of us at CVS ...Director (Cardiology) that can be remote based, work from home . This role can be remote based anywhere in… more
- CVS Health (Jackson, MS)
- Bring your heart to CVS Health . Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health . This purpose ... guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in...care resources. This is a remote based (work from home ) position. Ideal Candidates will reside in Georgia, Louisiana,… more