- Highmark Health (Charleston, WV)
- …Medicaid HEDIS and risk revenue programs and clinical evidence-based guidelines.The Medicare Advantage Quality Consultant is expected to assess the ... or exceeded. Further, in a matrix management environment, the Medicare Advantage Quality Consultant is...as needed/defined by market outcomes. + Serve as the clinical subject matter expert for PCP Medicare … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …As an integral part of HMM Quality and Compliance team, the Senior Medicare Clinical Compliance Consultant works through the influence as an individual ... and escalate to senior leaders for decision making + Apply their clinical knowledge when assessing/auditing medical records and UM letters against medical necessity… more
- Prime Therapeutics (Columbus, OH)
- …our passion and drives every decision we make. **Job Posting Title** Medicare Health Plan Operations Specialist - Remote **Job Description** The Associate Functional ... Business Consultant serves as a business system or business process...healthcare experience + Experience using queries + Experience with Medicare Part D **Minimum Physical Job Requirements** + Occasional… more
- VHC Health (Arlington, VA)
- Senior Quality Consultant Job Description Purpose & Scope: The Quality Team is responsible for supporting the organization in four essential domains which ... include Patient Safety, Clinical Quality Management, Regulatory Compliance, and Performance...& safety improvement initiatives. Key functions of the Senior Quality Consultant include collaborating with quality… more
- US Tech Solutions (RI)
- …clinician support as required. **Responsibilities:** + Reviews documentation and evaluates potential quality of care issues based on clinical policies and ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation. + Reviews documentation and interprets data obtained from… more
- US Tech Solutions (May, OK)
- … of Care cases across all lines of business (Commercial and Medicare ). Independently coordinates the clinical resolution with internal/external clinician support ... as required. **Responsibilities:** + Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations.… more
- WellSense (Boston, MA)
- Sr. Provider Relations Consultant - (MA residents)-$5000 sign on bonus WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25...prepares and conducts orientations of network providers (administrative and clinical ) and their staff + Takes the lead on… more
- WellSense (Boston, MA)
- Provider Relations Consultant (Boston/Northeast MA) - $5,000 sign on bonus! WellSense Health Plan is a nonprofit health insurance company serving members across ... Massachusetts and New Hampshire through Medicare , Individual and Family, and Medicaid plans. Founded 25...no matter their circumstances. As a WellSense Provider Relations Consultant , you'll act as the primary liaison between WellSense's… more
- CVS Health (Plantation, FL)
- …along with Patient Safety Events across all lines of business (Commercial, Medicare , and Medicaid). Independently coordinates the clinical resolution with ... support as required + Reviews documentation and evaluates Potential Quality of Care issues based on clinical ...Potential Quality of Care issues based on clinical policies and benefit determinations. + Considers all documented… more
- Humana (Frankfort, KY)
- …they need, when they need it. These efforts are leading to a better quality of life for people with Medicare , Medicaid, families, individuals, military service ... growth across Humana's businesses by tailoring our offerings, go-to-market strategies, and clinical experiences to the unique needs of strategic populations such as… more
- CVS Health (Columbus, OH)
- …EST. Holiday rotation 1-2 per year. Position Summary CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to ... care more personal, convenient and affordable. This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any state.Normal… more
- CVS Health (Lansing, MI)
- …fully remote and employee can live in any state. CCR - Duals UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process to assess, ... options to facilitate appropriate healthcare services/benefits for members. Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
- St. Luke's University Health Network (Allentown, PA)
- …Hospital. SLUHN is the only Lehigh Valley-based health care system to earn Medicare 's five-star ratings (the highest) for quality , efficiency and patient ... of a patient's ability to pay for health care. The Lactation Consultant is responsible for promoting and coordinating patient care and educational activities… more
- MyFlorida (Fort Pierce, FL)
- OPERATIONS & MGMT CONSULTANT II - SES - 64004774 Date: May 29, 2024 Location: FORT PIERCE, FL, US, 34950 The State Personnel System is an E-Verify employer. For more ... Agency: Department of Health Working Title: OPERATIONS & MGMT CONSULTANT II - SES - 64004774 Pay Plan: SES...incident and/or safety hazard reports. Assures county health department clinical staff has access to HIV/AIDS training. Attend local… more
- Vatica Health (Warren, PA)
- …clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant , you will collect, review and analyze patient data to improve care ... coordination, quality metrics, and medical cost savings. The ideal candidate...and consolidate into one comprehensive and detailed view. Use clinical judgement and data to reconcile conflicting information from… more
- Vatica Health (Atlanta, GA)
- …clinically experienced and detailed-oriented nurses to join our team. As a Nurse Consultant , you will collect, review and analyze patient data to improve care ... coordination, quality metrics, and medical cost savings. The ideal candidate...and consolidate into one comprehensive and detailed view. Use clinical judgement and data to reconcile conflicting information from… more
- CVS Health (Lansing, MI)
- …is required.Applicants from any state can apply. Prior Authorization UM Nurse Consultant Utilizes clinical experience and skills in a collaborative process ... Nursing experiencePreferred Qualifications Prior authorization utilization experience preferred Outpatient Clinical experience Knowledge of Medicare /Medicaid Managed care… more
- CVS Health (Columbus, OH)
- …personal, convenient and affordable. Position Summary This Utilization Management (UM) Nurse Consultant role is fully remote and employee can live in any ... Time Holiday rotation 1-2 per year. CCR - Duals UM Nurse ConsultantUtilizes clinical experience and skills in a collaborative process to assess, plan, implement,… more
- CVS Health (Columbus, OH)
- …care more personal, convenient and affordable. Position Summary Duals UM Nurse Consultant Pennsylvania - Institutional Special Needs Plan (PA ISNP) Scheduled : ... Monday through Friday 9:30am to 6:00pm EST zone Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor… more
- CVS Health (Austin, TX)
- …personal, convenient and affordable. Position Summary Precertification: Utilization Management Nurse Consultant + Utilizes clinical experience and skills in a ... to facilitate appropriate healthcare services/benefits for members. + Gathers clinical information and applies the appropriate clinical criteria/guideline,… more
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