- Humana (Salt Lake City, UT)
- …Operations at Humana to define, prioritize and execute on utilization management -focused initiatives to drive appropriate care in order to improve cost ... identify opportunities in driving appropriate clinical decisions for members through utilization management /prior authorization process + Size impact of… more
- Molina Healthcare (UT)
- **Job Description** **Job Summary** This AVP , National Ancillary Contracting & Network Strategy will have direct responsibility over strategy and negotiations for ... DME, dialysis, lab, vision and transportation. Corporate Network Management leadership position contributes to developing and deploying tools, templates, training… more
- Molina Healthcare (UT)
- …of claims and maintain compliance TAT requirements. * Partners with HP CMOs, Utilization Management , and Shared Services teams to identify Pre-Pay and Post-Pay ... **Job Description** **Job Summary** The AVP , Clinical Validation (PI) role within Payment Integrity...all lines of business, which may also include the Care Management application for UM functions within… more
- Prime Therapeutics (Salt Lake City, UT)
- …drug management strategy for the designated clinical product domain (ie Utilization Management , Formulary, Concurrent and Retrospective Drug Utilization ... quality improvement plans to ensure the outcome improves cost and quality of care and assures regulatory compliance + Manage the implementation of new clinical… more