- Humana (Hartford, CT)
- …Degree or BSN degree. + Minimum 3 years of experience in NCQA Health Plan Accreditation and/or Utilization Management + Exceptional attention to detail. + ... help us put health first** We are seeking a Senior Accreditation Professional who will work in...on NCQA accreditation standards, especially related to Utilization Management and/or Behavioral Health; MED-Deeming … more
- The Cigna Group (Bloomfield, CT)
- …Strategist Sr Advisor will hold a key role in in ensuring that our utilization management (UM) policies align with clinical guidance, drive formulary intent, and ... + Minimum of 4 years of experience in healthcare utilization management or a related field. +...Council for Prescription Drug Programs (NCPDP), URAC, and NCQA accreditation . + Ability to work independently and adapt quickly… more
- Evolent (Hartford, CT)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... , you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Humana (Hartford, CT)
- …a part of our caring community and help us put health first** The Senior Utilization Management Behavioral Health Professional utilizes behavioral health ... and communication of medical services and/or benefit administration determinations. The Senior Utilization Management Behavioral Health Professional work… more
- Elevance Health (Wallingford, CT)
- …Senior Leadership Teams in the areas of medical provider relations, quality management , utilization management , clinical systems design, and clinical ... the state employed. **Preferred Skills, Capabilities and Experiences** + **Leadership & Utilization Management :** Prior leadership role in a managed care… more
- Evolent (Hartford, CT)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... the mission. Stay for the culture. **What You'll Be Doing:** **Cardiovascular Utilization Management Reviewer (Interventional Cardiologist)** Are you ready to… more
- Evolent (Hartford, CT)
- …selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical Director. ... Director you will be a key member of the utilization management team. We can offer you... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent (Hartford, CT)
- …Doing:** Job Description As a FMD, Radiology you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Athena Health Care Systems (Farmington, CT)
- …available to personnel. + Ensuring coordination with other departments, services, and senior management , as appropriate. + Ensuring staff and organization stay ... preferred. + Two (2) to five (5) years experience in health care management required. + Understanding of hospice care, Medicare Hospice Certification, and corporate… more
- Evolent (Hartford, CT)
- …members and providers + Appropriately identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately ... policies + Creates adverse determination notifications that meet all accreditation , State, and Federal criteria + Uses Plain Language...identifies potential cases for Care Management programs + Communicates appropriate information to other staff… more