- CVS Health (Dover, DE)
- … clinical skills to coordinate, document, and communicate all aspects of the utilization /benefit management program. + Conduct clinical reviews for adult ... internal and external constituents in the coordination and administration of the utilization /benefit management function. + Gathers clinical information and… more
- Highmark Health (Dover, DE)
- …needs and the analytical technology team. The Senior Decision Support Consultant will leverage technical, analytical, and business expertise to design, develop, ... while also being capable of developing technical solutions. The consultant will act as a senior resource within the...the impact of Highmark's business decisions on Informatics, personnel utilization , and the use and planning of technology. The… more
- Penn Medicine (Philadelphia, PA)
- …Research with a focus on supply chain, patient throughput, resource allocation and utilization , queuing theory and capacity management to help optimize business ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- Deloitte (Philadelphia, PA)
- Healthcare Clinical Documentation Specialist - Senior Consultant Our Deloitte Regulatory, Risk & Forensic team helps client leaders translate multifaceted risk ... for both formal and informal education of physicians, CDI team, health information management and other clinical staff + Develop in-service education tools as… more
- Highmark Health (Wilmington, DE)
- …for innovation and ensure compliance with evolving regulations. By leveraging clinical expertise and strategic thinking, the consultant drives data-informed ... in partnership with our external entity partners + Provide Clinical Expertise and stakeholder engagement for all VBR contracts...Quality Improvement + 3 - 5 years in Care Management + 3 - 5 years in Utilization… more
- Penn Medicine (Philadelphia, PA)
- …leading and managing their departments with a focus on driving change and utilization of change management tools. + Completes on-boarding interviews within the ... Working for this leading academic medical center means collaboration with top clinical , technical and business professionals across all disciplines. Today at Penn… more
- CVS Health (Dover, DE)
- …relations; customer service or audit experience. Experience in research and analysis of utilization management systems. *Fluent in Spanish, both oral and written ... accuracy and appropriateness of a benefit/administrative denial. Can review a clinical determination and understand rationale for decision. Able to research claim… more