- Humana (Montgomery, AL)
- …would be a great fit if * You are passionate about Utilization Management - you're motivated by driving positive health outcomes for members and reducing ... part of our caring community and help us put health first** The Clinical Strategy team is a multi-disciplinary...will generate tangible value for all stakeholders. Within the Utilization Management (UM) Strategy team, our goal… more
- Evolent Health (Montgomery, AL)
- …the mission. Stay for the culture. **What You'll Be Doing:** The **Coordinator, Intake Utilization Management ** at Evolent will serve as a point of contact for ... and client contractual agreements. **Collaboration Opportunities** : The Coordinator, Intake Utilization Management reports directly to the Manager, Client… more
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** The Utilization Management Clinical Pharmacist 2 (VSP/PT) is a clinical pharmacist who ... and comprehensive medication reviews for prescriptions requiring pre-authorization. The Utilization Management Clinical Pharmacist 2 (VSP/PT) work assignments… more
- Humana (Montgomery, AL)
- **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 ... and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments are varied and… more
- Evolent Health (Montgomery, AL)
- …Director for select health plans or regions, assuming overall accountability for utilization management while working in conjunction with the SVP, CCO and/or ... department, you will be a key member of the utilization management team. We can offer you...outcomes. **Collaboration Opportunities:** + Routinely interacts with leadership and management staff, other Medical Directors, and health … more
- Evolent Health (Montgomery, AL)
- …Field Medical Director- Physical Health , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Initial Clinical Reviewers. **What you'll be doing:** + Supports pre-admission review, utilization management , and concurrent and retrospective review process. +… more
- Evolent Health (Montgomery, AL)
- …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...Reviewer you will be a key member of the utilization management team. We can offer you… more
- Evolent Health (Montgomery, AL)
- …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 (Montgomery, AL)
- …teams focusing on quality management , utilization management , case management , discharge planning and/or home health or post-acute services such ... Systems, health insurance, other healthcare providers, clinical group practice management + Utilization management experience in a medical management … more
- Humana (Montgomery, AL)
- …and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health , Social Determinants of ... Health , Pharmacy, Behavioral Health , Institutional Long-Term Services and Supports (LTSS), ...Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy. **Alternatively** **,** 5+ years… more
- Sharecare, Inc. (Montgomery, AL)
- …/ 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 (Montgomery, AL)
- …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
- Evolent Health (Montgomery, AL)
- …Codes, CPT Codes, RVUs, bundled payments, including value-based care and utilization management - **Required.** + Experience in developing regulatory reporting ... **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes...trends, medical economic KPIs (eg PMPM), and drilling into cost/ utilization patterns to identify cost/use drivers - **Required** +… more
- Humana (Montgomery, AL)
- …hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers + Utilization management experience in a medical management review ... part of our caring community and help us put health first** The Medical Director actively uses their medical...with prior experience participating in teams focusing on quality management , utilization management , and acute… more
- Evolent Health (Montgomery, AL)
- **Your Future Evolves Here** Evolent partners with health plans and providers to achieve better outcomes for people with most complex and costly health ... across specialties and primary care, we seek to connect the pieces of fragmented health care system and ensure people get the same level of care and compassion… more
- Humana (Montgomery, AL)
- …with various stakeholders to drive strategic advancements in the Clinical - Utilization Management operating model. The Advisor must exercise independent ... part of our caring community and help us put health first** The Strategy Advancement Advisor plays a crucial...**Manage the operating model elements of the Clinical - Utilization Management (UM) domain** + Serve as… more
- Veterans Affairs, Veterans Health Administration (Tuskegee, AL)
- …and counsel Veterans and families Serves as a role model for utilization of appropriate communication and conflict management techniques, effectively guiding ... introduce the Veteran to the "face" of VA Behavioral Health Service while inpatient at the non-VA inpatient mental...up to date and accurate in CPRS. Conduct follow-up home visits when Veteran does not show for first… more
- CVS Health (Montgomery, AL)
- 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...care resources. This is a remote based (work from home ) position. Ideal Candidates will reside in Georgia, Louisiana,… more
- CVS Health (Montgomery, AL)
- …consistent responses to members and providers. You will lead all aspects of utilization review/quality assurance, directing case management . In this role you ... Bring your heart to CVS Health . Every one of us at CVS ...care resources. **This is a remote based (work at home ) based anywhere in the US.** The Medical Director… more
- CVS Health (Montgomery, AL)
- …consistent responses to members and providers. In addition you will oversee utilization review/quality assurance, directing case management . In this role you'll ... Bring your heart to CVS Health . Every one of us at CVS ...care resources. **This is a remote based (work from home ) role preferably resides in North Carolina and have… more