- Elevance Health (Tampa, FL)
- …of associates and may be involved in process improvement initiatives within the utilization management function. Examples of such functions may include: review ... **Licensed Utilization Review Senior ** _Location:_ While remote,...medically appropriate, quality, cost effective care throughout the medical management process. + Educates the member about plan benefits… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient &… more
- Fallon Health (Worcester, MA)
- …of corporate-wide functions such as quality improvement, credentialing, member rights, utilization management , including member appeals and grievances to support ... direction from the Director of Quality, the Program Manager, Accreditation & Audit ensures that the health plan is...regulatory environment to promote awareness with other directors and senior leaders of the health plan the impact of… more
- Centene Corporation (Madison, WI)
- …knowledge of regulations, accreditation standards, and industry best practices related to utilization management + Works with utilization management ... ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks...applicable guidelines, policies, and procedures + Works with the senior management to develop and implement UM… more
- HCA Healthcare (Nashville, TN)
- …assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management , peer review, medical staff and board bylaws, ... that invests in you as a(an) Director Regulatory and Accreditation ? At HCA Healthcare, you come first. HCA Healthcare...division vice president, quality or director, quality and risk management . Up to 75% TRAVEL REQUIRED Major Responsibilities *… more
- Huron Consulting Group (Chicago, IL)
- …as the expert you are now and create your future. **Qualifications** The Utilization Management Specialist is responsible for ensuring the appropriate ... to facilitate optimal patient outcomes while managing healthcare costs. The Utilization Management Specialist ensures compliance with regulatory requirements and… more
- Elevance Health (Tampa, FL)
- Senior RN Utilization Review/ Management (Acute InPatient) JR116937 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This ... of Florida. + Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination of education… more
- WellSense (Boston, MA)
- …that works for our members, no matter their circumstances. **Job Summary:** The Senior Manager of Clinical Utilization Management (UM), Behavioral Health ... improvement of existing department policies and procedures and works with department senior management for implementation; follows through with evaluation. +… more
- Martin's Point Health Care (Portland, ME)
- …experience in health care including experience in care management / disease management , utilization management and prior authorization. + Experience ... activities, objectives, and analysis for the Martin's Point Health Plan. The Senior Director is responsible for Care Management design, implementation and… more
- Magellan Health Services (Albuquerque, NM)
- …the delivery of appropriate health care by overseeing the service coordination, utilization management , care/case management , population health/disease ... all health plans overseen by the assigned position which includes metrics for utilization and quality management . Develops mitigating strategies to ensure goals… more
- Houston Methodist (Houston, TX)
- …of the clinic network, assist in the development of regional strategic direction with Senior leadership, serve as the primary liaison with physicians in SPG and PCG ... secure compliance with ethical and legal business practices and accreditation /regulatory/government regulations. **PEOPLE ESSENTIAL FUNCTIONS** + Directs, develops and… more
- Binghamton University (Binghamton, NY)
- …maintenance of faculty credential (licensure, CPR, etc.) tracking. + Assist with management of systems for organizing accreditation documents, records, and files ... Professional Posted On: Wed Jul 24 2024 Job Description: Budget Title: Senior Staff Assistant (SL-3) Salary: $55,151 + (dependent on experience) Binghamton… more
- Veterans Affairs, Veterans Health Administration (San Diego, CA)
- …oversight to the educational and research missions of the MHCL. Collaborate with senior management officials and service chiefs to negotiate, persuade, decide ... health care to veteran in the context of appropriate utilization of resources. Establish MHS objectives congruent with and...using data tools for collection and analysis. Collaborate with senior management officials including the Chief of… more
- ManTech (Chantilly, VA)
- …detection; contingency planning; incident handling; configuration control; change management ; auditing; certification and accreditation process; principles ... security authorization activities in compliance with Information System Certification and Accreditation Process (ICD 503), the NIST Risk Management Framework… more
- ManTech (Chantilly, VA)
- …detection; contingency planning; incident handling; configuration control; change management ; auditing; certification and accreditation process; principles ... security authorization activities in compliance with Information System Certification and Accreditation Process (ICD 503), the NIST Risk Management Framework… more
- Ventura County (Ventura, CA)
- …of assigned professional and technical reporting staff; assumes ongoing project management responsibilities ( Senior ), the Systems Finance Analyst evaluates ... classification and eligible for overtime compensation. The Financial Analyst II and Senior are Management exempt classifications and not eligible for overtime… more
- City of New York (New York, NY)
- …content for Professional Development training including but not limited to: Senior Management Training, Career Development, Youth Development Programming and ... activities and curricula related to Youth Program observation and evaluation, project management , utilization of Microsoft products (such as Excel, PowerPoint,… more
- Johns Hopkins University (Baltimore, MD)
- …administrative teams including clinic staff meetings, case consultation, high-risk case management , peer chart reviews, medical leave review, accreditation , and ... learners. Reporting to the Director of Clinical Services, the Senior Associate Director is a key member of the...a keen understanding of clinical service delivery models, data management , and reporting. The service model will incorporate a… more
- Veterans Affairs, Veterans Health Administration (Yakima, WA)
- …data reported by local housing authorities and on the Homeless Operations Management and Evaluation System (HOMES) for each team is accurate. Responsibilities ... INCENTIVE FUNCTIONS OF THE POSITION Expert and independent case management for a caseload of veterans in the HUD-VASH...Maintains data and statistical compilations that track current voucher utilization by members of the team reported by HOMES… more
- Sharp HealthCare (San Diego, CA)
- …Start Time** **Shift End Time** Six Sigma Yellow Belt Certification - Various-No accreditation board **Hours** **:** **Shift Start Time:** 8 AM **Shift End Time:** ... subject matter experience. + 3 Years system analyst role. + Project Management experience. + Six Sigma Yellow Belt Certification - Various-No accreditation… more