- Highmark Health (Charleston, WV)
- …standards, and practitioner/provider education. The incumbent is an integral part of the utilization management team and assists utilization management ... State of West Virginia **ESSENTIAL RESPONSIBILITIES** + Communicate effectively. + Review utilization management cases and communicate the decisions to the… more
- CenterWell (Charleston, WV)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Highmark Health (Charleston, WV)
- …account, and member educational initiatives that promote the Organization's Formularies, utilization management programs, and case/ disease management ... information to improve individual outcomes as an adjunct to health coaching. If acting in the capacity as a...review. + Assist in the development and implementation of utilization management programs including but not limited… more
- Highmark Health (Charleston, WV)
- …of clinical, case/ utilization management and/or disease/condition management experience, or provider operations and/or health insurance experience ... health status/severity and clinical needs; and assesses health management needs of the assigned member...clinical care is being provided. **Preferred** + Certification in utilization management or a related field +… more
- Highmark Health (Charleston, WV)
- …Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health care services, ... utilization , identification of opportunities for referral to a Health Coach/case management , and identification and resolution...position adheres to the ethical and legal standards and behavioral expectations as set forth in the code of… more
- Highmark Health (Charleston, WV)
- …for the patient, and then creates the case (data entry) in Highmark's utilization management system for clinical review. Ensures all accurate information is ... including verification of benefit eligibility. Build cases in the utilization management system. + Use knowledge of...0 - 1 year of experience working in the Health Insurance Industry **LICENSES AND CERTIFICATIONS** **Required** + None… more
- BrightSpring Health Services (Dunbar, WV)
- …Community Living, Adult Host Homes for adults regardless of disability, Behavioral /Mental Health Support, In-home Pharmacy Solutions, Telecare and Remote ... ResCare Community Living Overview This position plans, directs, and coordinates health services for all assigned service sites. Provides oversight and direction… more
- Highmark Health (Charleston, WV)
- …:** **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and ... (DO) **Substitutions** + None **Preferred** + Master's Degree in Business Administration/ Management or Public Health **EXPERIENCE** **Required** + 5 years… more
- Highmark Health (Charleston, WV)
- …, physician practice management or clinical operations, ancillary provider management or clinical operations, and/or health insurance) with significant ... knowledge of and experience with various care delivery models + Experience in health plan provider network performance management , care/case management ,… more
- Highmark Health (Charleston, WV)
- **Company :** Highmark Health **Job Description :** Job Description **JOB SUMMARY** This role within the marketing & experience department will be at the forefront ... includes leveraging cutting-edge customer experience platforms, implementing robust data management solutions, and optimizing marketing automation tools to drive… more
- Highmark Health (Charleston, WV)
- …departments including but not limited to Provider Relations, Claims, Program Integrity, Utilization Management . + Stay current on new reimbursement strategies ... and overseeing the negotiation and execution of the plan's contracts with health care providers that drive high-quality care for our members, while maintaining… more
- Highmark Health (Charleston, WV)
- …resource efficiency. + Proposes ideas, designs, and solutions to lead engineers and management to further cloud service utilization and optimization. + Develops ... **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job...of action. + Level 3 Incident, problem and change management as it pertains to the responsibilities of the… more
- Highmark Health (Charleston, WV)
- …actions (promotions, hiring, terminations, etc.) Develops talent, Addresses resource management , cultivates capabilities of staff, planning and coordination of work, ... in first-line resolution of complex technical problems 2. Provides Staff Management oversight * Hires, promotes, separates or makes recommendations regarding same… more
- Highmark Health (Charleston, WV)
- **Company :** Highmark Health **Job Description :** **JOB SUMMARY** This job is a strong advocate of cloud technology and engineering support necessary to drive the ... to senior or lead engineers to further cloud service utilization and optimization. + Develops automation scripts and other...of action. + Level 2 Incident, problem and change management as it pertains to the responsibilities of the… more
- Sharecare, Inc. (Charleston, WV)
- …of the health care team to support appropriate total healthcare management and ensure cost effective, appropriate resource utilization and quality outcomes. ... team. Facilitates communication exchange with primary managing physician and other providers, health plan, and the disease management program team. + Coordinates… more
- CenterWell (Charleston, WV)
- …that impact patient well-being. Our integrated care teams, which include physicians, nurses, behavioral health specialists and more, spend up to 50 percent more ... leader will play a critical role in ensuring optimal patient care, high quality health outcomes, and improved cost and utilization in pharmacy-related care, and… more
- Compass Group, North America (Newell, WV)
- …[[14]] Other Forms of Compensation: [[n/a]] ESFM is the corporate Integrated Facilities Management (IFM) division of Compass Group USA and a Keystone member of the ... provided to clients. Their portfolio of service categories includes Environment, Health & Safety, Facilities Maintenance & Engineering, Sustainability, Janitorial &… more
- Marriott (Charleston, WV)
- …States **Schedule** Full-Time **Located Remotely?** Y **Relocation?** N **Position Type** Management **JOB SUMMARY** Marriott has an exciting opportunity for a ... business systems (APIs, middleware tools etc.) + Understanding of environment management , release management , code versioning best practices, and deployment… more
- Compass Group, North America (Charleston, WV)
- …platform includes the latest in healthful eating and an understanding of behavioral change in food consumption. Morrison's alignment with Partnership for a Healthier ... necessary product is available when needed + Makes all decisions regarding utilization of leftover food products staying within Company guidelines for such products… more