- CommonSpirit Health (Englewood, CO)
- **Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews referred by case ... management staff and/or other health care professionals to meet regulatory requirements and in accordance...and health information personnel. + **Conducts peer-to-peer reviews with payer medical directors to discuss and advocate for the… more
- CommonSpirit Health Mountain Region (Salt Lake City, UT)
- …roles, preferred. + Experience as a Physician Advisor in the acute care setting and/or the payer environment, preferred. + Education and experience in ... and Kansas, we deliver the same high standard of care to our employees as we do to our...position is a hybrid role requiring a mix of remote and on-site work at the five CommonSpirit Hospitals… more
- The Cigna Group (Bloomfield, CT)
- **Work Location: Remote - Work at Home** The **Competitive Unit Cost Advisor ** will focus on the analysis of competitive unit cost information, validation of ... COB, MCR/State Cost Data, UC Plan, Hospital Transparency Analytics, Payer Transparency Analytics, NS&E updates, Local Market Affordability reviews, Market/Provider… more
- Tufts Medicine (Burlington, MA)
- …require additional hours on weekends/off hours as needed. **Location:** Primarily remote . May require occasional travel to local facilities including Tufts Medical ... of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. The health system is the… more
- UNC Health Care (Chapel Hill, NC)
- …conditions, patient safety indicators, hierarchical condition categories and complexity of care rendered to all patients. Educates on proper creation of provider ... CPT codes in accordance with the Official Coding Guidelines, and third party payer , state and federal regulations. 10. Identifies cases for CDI Physician Advisor… more
- University of Michigan (Ann Arbor, MI)
- RN CASE MANAGER: University Hospital ( Care Management) Apply Now **Job Summary** The RN Case Manager assesses, develops, implements, coordinates and monitors a ... comprehensive plan of care for each patient/family in collaboration with the physician,...admission; review every 3 days or as requested by payer + Determine patient classification with provider and ensure… more
- Humana (Sacramento, CA)
- …Partner with national innovation teams to pilot and scale emerging technologies and care models (eg, remote monitoring, clinical pathways, tech-enabled care ... and cross-functional collaboration. The RVP acts as a key advisor , innovator, and relationship builder, ensuring alignment with Humana's...years clinical practice + 5 + years in managed care industry, either provider or payer . +… more
- Bristol Myers Squibb (Princeton, NJ)
- …Commercial, Medical, Regulatory and Clinical Development. He/she will be an important advisor of the Commercial Development Operating Committee (CDOC) and **Asset & ... strategies and access advice for Oncology products through: evaluating payer insights/perspectives; assessing payer appropriateness of clinical development… more
- Novant Health (Charlotte, NC)
- …goals. The Manager, Payor Strategy and Relationship Management is a professional advisor supporting managed care contracts with health plans, payors, employer ... The Manager may be responsible for certain portfolio of payer relations and the contract language and rate negotiations...existing and emerging healthcare economic trends. **This is a Remote Position Responsibilities + Commercial Managed Care … more
- Otsuka America Pharmaceutical Inc. (Des Moines, IA)
- …are key. + Background in specialty pharmacy business development, healthcare consulting, payer relations, or value-based care models. + Understanding regulatory ... Otsuka Precision Health is a health experience company that brings personalized care within reach through products and services for mental and physical well-being.… more
- Arnot Health (Elmira, NY)
- Job Description Remote work available! Up to $10,000 Sign on Bonus for qualified Case Managers! MAIN FUNCTION: The Case Management (denial/prior auth) will review ... and trend, record and collect patient accounts denied by payer . Under the direction of the System Director of.... Under the direction of the System Director of Care Coordination coordinates data with other Arnot Health departments… more
- Virtua Health (Pennsauken, NJ)
- …the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing ... care , or something in-between - we are your partner...for pediatrics. Location: Pennsauken - 6991 North Park Dr. Remote Type: On-Site Employment Type: Employee Employment Classification: Per… more
- Evolent (Helena, MT)
- …a bold mission to change the health of the nation by changing the way health care is delivered. Our pursuit of this mission is the driving force that brings us to ... clinical outcomes to identify cost drivers, utilization patterns, and opportunities for integrated care solutions using SQL, SAS, Excel, and Power BI (or similar BI… more
- Ascension Health (St. Louis, MO)
- …quality outcomes and financial success + **Department:** Revenue Cycle + **Location:** Remote **Benefits** Paid time off (PTO) Various health insurance options & ... revenue cycle functions. + Ensure compliance with all federal, state, and payer regulations related to coding, documentation, and revenue integrity. + Manage… more