- Catholic Health Services (Melville, NY)
- …communicate and manage project scope; Assist in work plan development and management ; contributes to completion of project status reports. Lead meetings with staff ... planning, organizing, and managing resources) and all phases of the project management life cycle for a variety of initiatives Actively responds to questions… more
- Elevance Health (Richmond, VA)
- **Title: Grievance/ Appeals Analyst II** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst II** will be responsible for...customer expectations and responses. + Responsibilities exclude conducting any utilization or medical management review activities which… more
- Elevance Health (Los Angeles, CA)
- **Title: Grievance/ Appeals Analyst I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 miles of ... one of our PulsePoint locations. The **Grievance/ Appeals Analyst I** is an entry level...to convey the determination. + Responsibilities exclude conducting any utilization or medical management review activities which… more
- Henry Ford Health System (Troy, MI)
- …experience . + Minimum of two (2) years of experience working on utilization management platform-processing authorizations. + Minimum of two (2) years of ... prompt and thorough investigation of medical, transportation, and pharmacy member appeals and grievances for Health Alliance Plan's (HAP's): Commercial, Medicare… more
- The Cigna Group (Bloomfield, CT)
- …for providers, members and patient client advocates within the Prior Authorization/ Utilization Management department. Identify and track trends for analytics ... Nurse Case Management Lead Analyst -Nurse Clinician - Accredo...years of experience is preferred in prior authorization or utilization review and appeals + Demonstrated proficiency… more
- MSys Inc. (Harrisburg, PA)
- …of healthcare operations to include: enrollment, claims, customer service and appeals . + Demonstrated project management experience. + Applied analytical ... Job summary: Title: Healthcare Data Analyst -Hybrid Location: Harrisburg, PA, United States Length...healthcare operations to include: enrollment, claims, customer service and appeals . + Experience in Healthcare Quality measures, utilization… more
- The Cigna Group (Bloomfield, CT)
- …shifts with every other weekend (Tuesday ALT Day).** + Must have experience in Medicare Appeals , Utilization Case Management or Compliance in Medicare Part C ... + Ability to differentiate different types of requests Appeals , Grievances, coverage determination and Organization Determinations in order to ensure the correct… more
- City and County of San Francisco (San Francisco, CA)
- …customers regarding electronic system development, implementation, issues, and recommendations and utilization of best practices; + Work with the EHR implementation ... requirements; + Evaluate workflows and recommend re-engineering of processes around utilization of computerized applications, including the new EHR to improve the… more
- Clark County, NV (Las Vegas, NV)
- SENIOR ENTERPRISE SYSTEMS ANALYST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4647253) Apply SENIOR ENTERPRISE SYSTEMS ANALYST ... seeking qualified candidates to join our team as a Senior Enterprise Systems Analyst located within the Enterprise Resource Planning (ERP) office. We are looking for… more
- City and County of San Francisco (San Francisco, CA)
- …external customers regarding electronic system development, implementation, issues, recommendations, and utilization of best practices + As a member of a ... good working relations with department personnel, staff, vendors, peers, and management + Maintaining all system configuration and build parameters for application… more
- Clark County, NV (Las Vegas, NV)
- SENIOR NETWORK ANALYST Print (https://www.governmentjobs.com/careers/clarkcounty/jobs/newprint/4651374) Apply SENIOR NETWORK ANALYST Salary $35.38 - $54.88 ... Technology department is seeking qualified candidates to apply for the Senior Network Analyst position. As a member of our team you will install, support and… more
- Heidelberg Materials US, Inc. (Irving, TX)
- …asphalt, and related construction materials. Heidelberg Materials is seeking a qualified Tax Analyst to join our team in Irving, Texas. **What you'll get to do** ... federal, state and local income and franchise tax audits, appeals and litigation for the US group. + Assist...and engagement through high level of work ethic and utilization of abilities for the best of the company.… more
- Magellan Health Services (Albuquerque, NM)
- …providers and members to manage cost of care. Oversees utilization management and criteria-based reviews of care, clinical appeals regarding medical ... and vendors to assure integration, oversight, and efficiency of utilization management and appeals processes...and Certifications - Required BCBA - Board Certified Behavior Analyst - Care Mgmt, LCMFT - Licensed Clinical Marriage… more
- City and County of San Francisco (San Francisco, CA)
- …its Managed Care division which oversees the Office of Coordinated Care (OCC), Utilization Management (UM), and Quality Management (QM). Additionally, BHS ... with the Director of Managed Care and with OCC, Utilization Management (UM), and Quality Management...to change after adoption (eg, as a result of appeals ), as directed by the Human Resources Director or… more
- City and County of San Francisco (San Francisco, CA)
- …divisions operating on the campus, including nursing, physicians, risk management , quality, capital projects, biomed, material management , finance/accounting, ... to patients at Zuckerberg San Francisco General Hospital, ensuring the efficient management of daily operations within the acute care pharmacy. + Develops and… more
- Blue Cross and Blue Shield of Louisiana (Baton Rouge, LA)
- …documents. Writes draft medical policies for Blue Advantage MA and Primewell Utilization Management Committee functions specific to medical policies and supports ... implement approved policies. + Coordinates the Blue Advantage MA and Primewell Utilization Management Committee functions specific to medical policies and… more
- City and County of San Francisco (San Francisco, CA)
- …presented to patient and others; + May conduct group psychotherapy and case management on a scheduled basis in connection with administering direct treatment to ... data and other critical factors. + Knowledge of principles of psychiatric case management refers to the understanding and the application of the theories and… more
- City and County of San Francisco (San Francisco, CA)
- …crisis intervention, outreach services, culturally competent interventions, case management and rehabilitation to clients enrolled in behavioral health ... data and other critical factors. + Knowledge of principles of psychiatric case management refers to the understanding and the application of the theories and… more
- LA Care Health Plan (Los Angeles, CA)
- Manager, Business Insights Job Category: Management /Executive Department: Advanced Analytics Lab Location: Los Angeles, CA, US, 90017 Position Type: Full Time ... enhancing analytics dashboards. Provide visualization on LA care clinical, utilization and financial performance. In partnership with other cross-functional leaders,… more