- Humana (Richmond, VA)
- …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
- Humana (Richmond, VA)
- …a part of our caring community and help us put health first** The Senior Compliance Nurse reviews utilization management activities and documentation to ... to prevent and detect fraud, waste, and abuse. The Senior Compliance Nurse work assignments involve moderately complex to...action + Minimum two, (2) years of experience in utilization management + Intermediate proficiency using Microsoft… more
- Battelle Memorial Institute (Crystal City, VA)
- …clients. The Cyber Architecture & Advisory Services is seeking a ** Senior Information Security Engineer** to support the Security Architecture and Security ... Authorization Process (Certification & Accreditation ) effort for a Department of Homeland Security Facility Monitoring System. This quick fill position is located at… more
- Bowman (Herndon, VA)
- **Short Description** Bowman has an opportunity for a Senior Commissioning Agent to join our team remotely in TX, PA, NJ or FL. At Bowman, we believe in creating ... construction. + Review project close-out documentation (O&M Manuals). + Maintain utilization targets. + Communicate effectively with client, internal project team,… more
- Evolent (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Evolent (Richmond, VA)
- …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
- HCA Healthcare (Reston, VA)
- …will assemble regional physician advisory panels to provide ongoing feedback to HCA senior management , and serves as a liaison between committees and ... review/ management + You will consult with facility-level staff regarding delegated utilization management and disease management operations under managed… more
- Evolent (Richmond, VA)
- …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 (Richmond, VA)
- …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
- Commander, Navy Installations (Norfolk, VA)
- …presents with special issues. Maintains case records, treatment plans, statistics and utilization rates in accordance with Navy policies and regulations and updates ... Provides after-hours coverage for the FFSP, when required. Performs FAP Case Management duties, which include receiving initial reports of suspected child and spouse… more
- Evolent (Richmond, VA)
- …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