- Elevance Health (Charleston, WV)
- ** Utilization Management Representative I** **Location** : This is a remote position. Ideal candidates will live within 50 miles of an Elevance Health ... location. Work Schedule : Monday - Friday 8am - 5pm The ** Utilization Management Representative I** is responsible for coordinating cases for… more
- Highmark Health (Parkersburg, WV)
- …drug policy, therapeutic alternatives, medication adherence strategies, Medication Therapy Management , utilization management , immunizations, specialty ... Delivery + Managed Care + Healthcare + Care Planning + Continuous Improvement + Utilization Management + Healthcare Management + Utilization Review… more
- RES (Charleston, WV)
- …routine maintenance schedules and communicates schedules for maintenance, repairs and utilization to Equipment Manager and field personnel. + Reviews third (3rd) ... to monitor repairs and ensure timely turnaround to keep utilization of assets high. + Oversees performance of and...& Abilities:** + Advanced knowledge in solar equipment + Management of multiple direct reports + Experience with diagnostic… more
- Highmark Health (Charleston, WV)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...+ Ability to visualize, articulate and solve complex problems representative of a broad range of service and claim… more
- Veterans Affairs, Veterans Health Administration (Clarksburg, WV)
- …and perform all administrative functions that include administration, human resource management , budget and finance, management and program analysis, office ... and information dissemination. The incumbent serves as the Contracting Officer Representative (COR) for the Surgery Service. The incumbent negotiates updates and… more
- Guardian Life (Charleston, WV)
- …attitude. You can collaborate with stakeholders to provide effective case management within the boundaries of contractual definitions. **You will:** + Assess ... providers to formulate viable return to gainful work plans. Cost effective utilization of vendors to provide rehabilitative services to support program goal.… more
- HealthEdge Software Inc (Charleston, WV)
- …support people need, when and where they need it. We call it Digital Health Management . Our comprehensive suite of Digital Health Management solutions for care ... ; ideally with a variety of experience in primary care, chronic disease management and/or public health. **Must have active license + Prior experience in **clinical… more
- CBRE (Charleston, WV)
- …13-Aug-2024 Service line GWS Segment Role type Full-time Areas of Interest Project Management Location(s) Phoenix - Arizona - United States of America, Remote - US ... healthcare vernacular. **What you'll do** Leads all facets of project management (budget, schedule, procurement, quality & risk) for individual healthcare projects… more
- Carrington (Charleston, WV)
- …operational report metrics. + Gain expert knowledge of the operational systems and utilization within the business process. + Act as the primary contact for ... technology, reporting and process related analysis. + Assist with scope management , change management and solution definition. + Create functional specifications… more
- Marathon Petroleum Corporation (West Union, WV)
- …and material selection, project bidding, contractor selection, construction oversight, management of change, personnel and process safety, environmental oversight ... to determine viability. Prepares decision support packages for review and approval by management . + Ability to manage DOT (CFR 192 & 195) regulated pipeline… more
- HealthEdge Software Inc (Charleston, WV)
- …Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC ( Utilization Review Accreditation Commission) and other State regulatory bodies. The ideal ... where they need it. We call it Digital Health Management . Our comprehensive suite of Digital Health Management...permanent **Work Environment:** The physical demands described here are representative of those that must be met by an… more
- Sutherland Global Services (Charleston, WV)
- …+ Billing Inquiries & Complaints + Authorizations + Status Inquiries + Utilization Management Inquiries **Eligibility and Benefits** + Status Inquiries + ... working in a high-volume call center environment as a customer service representative + Effective verbal and written communication skills + Strong typing and… more
- Sutherland Global Services (Charleston, WV)
- …of Benefits Requests + Authorizations + Status Inquiries + Denial Rationale + Utilization Management Appeals + Prior Authorization Verification + Eligibility and ... a high-volume call center environment as a customer service representative + Effective verbal and written communication skills +...skills with a strong attention to detail + Time Management skills + Sufficient Internet speeds while connected to… more
- Guardian Life (Charleston, WV)
- …negotiation skills. + The ability to accelerate impact and lead change. + Time management skills. **You will** + Manage PPO and DHMO recruitment efforts within your ... using market data to negotiate fee schedules and increasing utilization . + Speak to dentists/decision makers on the value...+ Complimentary 1:1 financial guidance with a licensed Fidelity representative **Time Off and Remote Work** + Flexible work… more