- Humana (Jackson, MS)
- …of the appropriate courses of action. The Utilization Management Nurse 2/ Home Health Utilization Management : + Review cases using clinical ... part of our caring community and help us put health first** The Utilization Management ...with no disciplinary action + Clinical experience in Medicare Home Health (in the last 12 months)… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the ... Qualifications** + Bachelor's Degree (BSN) + Utilization management experience is highly preferred + Health ...Medicare experience a plus + Milliman MCG experience preferred **Work-At- Home Requirements** To ensure Home or Hybrid… more
- CenterWell (Jackson, MS)
- …practice in a related specialty such as home infusion or specialty infusion, home health , oncology, IV therapy or critical care + Minimum 5 years nursing ... the following key functions: + Program evaluation + Risk Management + Utilization Review + Patient Care...such as home infusion or specialty infusion, home health , oncology, IV therapy or critical… more
- Evolent Health (Jackson, MS)
- …for selecting health plans or regions, assuming overall accountability for utilization management while working in conjunction with the Senior Medical ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes..., you will be a key member of the utilization management team. We can offer you… more
- CenterWell (Jackson, MS)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... Coordinate quality improvement activities to address high risk, high-utilizers/high-cost patient management through the utilization of the 5M's framework as… more
- Evolent Health (Jackson, MS)
- …Be Doing:** As a Physician Clinical Reviewer, you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... the Senior Medical Director in research activities/questions related to the Utilization Management process, interpretation, guidelines and/or system support. +… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- Marriott (Jackson, MS)
- …and Vocational Rehabilitation for injured workers per regional guidelines. + Oversee Home Health and Field Case Managers. **Claims Services** + Collaborate ... to Marriott's associates, Marriott Claims Services, business units, Risk Management and community health resources. Quality, cost...with Claims department regarding case management . + Collaborate with UNM on utilization … more
- CVS Health (Jackson, MS)
- Bring your heart to CVS Health . Every one of us at CVS Health shares a single, clear purpose: Bringing our heart to every moment of your health . This purpose ... guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Anchored in...typically limited to a 50 mile radius of employee's home . Hours for this position are Monday-Friday 8a-5p CST.… more
- Sharecare, Inc. (Jackson, MS)
- …/ new hire plan selection, claims issues, ID card issues, grievances/appeals, utilization management (UM) status, including but not limited to medical, ... + Claims adjustments + Grievances and appeals submissions + Utilization management intake or status + Complex...Assistant + Medical Secretary/Clinic Manager + Radiology Technician + Home Health Aide + Occupational Therapist Aide… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services (such ... meets compliance timelines. **This is a full-time work from home opportunity. Candidates may live anywhere in the US...health insurance, other healthcare providers, clinical group practice management . + Utilization management experience… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...to adapt and the courage to innovate **Work at Home Guidance** To ensure Home or Hybrid… more
- Evolent Health (Jackson, MS)
- …on an operational analytics team supporting Evolent's clinical services (ie, specialty care, utilization management , care management , appeals & grievances) + ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...all employees have the following technical capability at their home : High speed internet over 10 Mbps and, specifically… more
- Humana (Jackson, MS)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post acute services such ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … more
- CenterWell (Jackson, MS)
- … and full-risk frameworks, including patient engagement, clinical professional skillsets, utilization management , care management , clinical information ... directly address the complex needs of seniors and improve health outcomes and avoidable utilization (eg, palliative...senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Senior Process Improvement Professional analyzes, and measures the effectiveness of ... strategy with benchmarking, business process analysis and re-engineering, change management and measurement, and process-driven systems requirements. Job Responsibilities:… more
- CenterWell (Jackson, MS)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... 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
- iCIMS (Jackson, MS)
- …the Solution Consulting department including responsibility for the hiring, development, retention, utilization and management of the SCs and its leadership ... helping companies build a diverse, winning workforce and about building our home team. We're dedicated to fostering an inclusive, purpose-driven, and innovative work… more
- SHI (Jackson, MS)
- …implementing solutions within the customers managed platform or services under SHI's management . They must aim to achieve optimal system performance across all ... Product & MSP department, this remote position requires a home office setup, with occasional meetings at the SHI...occasional meetings at the SHI headquarters as determined by management . **About Us** Since 1989, SHI International Corp. has… more
- Humana (Jackson, MS)
- **Become a part of our caring community and help us put health first** The Senior Cloud Solutions Engineer (Network) develops and evaluates cloud network performance ... of cloud network eco-system, including performance, resiliency, availability, resource utilization and innovation. This person will provide cloud network design,… more