- Humana (Montgomery, AL)
- …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 (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 Process Improvement Professional 2 analyzes, and measures the effectiveness of existing ... following areas: benchmarking, business process analysis and re-engineering, change management and measurement, and/or process-driven systems requirements. Understands department,… more
- CenterWell (Montgomery, AL)
- …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 (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 ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience in a medical management … 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 ... health insurance, other healthcare providers, clinical group practice management . + Utilization management experience...participate on project teams or organizational committees. **Work at Home Guidance** To ensure Home or Hybrid… 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
- Humana (Montgomery, AL)
- …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
- Humana (Montgomery, AL)
- …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 (Montgomery, AL)
- … 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 (Montgomery, AL)
- **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
- Humana (Montgomery, AL)
- … first** The UM Administration Coordinator 2 contributes to administration of utilization management . The UM Administration Coordinator 2 performs varied ... or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed...time that is best for your schedule. **Work At Home / Internet Guidance:** To ensure Home … more
- CenterWell (Montgomery, AL)
- …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
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** Are you passionate about the Medicare population and looking for a role in healthcare ... and growth, both regionally and nationally. This is achieved through effective management and assessment of BRE activities, providing coaching where necessary, and… more
- CenterWell (Montgomery, AL)
- …largest provider of senior-focused primary care, one of the largest providers of home health services, and fourth largest pharmacy benefit manager, CenterWell is ... **Become a part of our caring community and help us put health first** The Patient Assessment and Navigation Professional oversees the enrollment, education,… more
- Humana (Montgomery, AL)
- **Become a part of our caring community and help us put health first** The Market Finance Lead collects, analyzes and reports on various market data to connect ... operational performance for the region + Leads Membership, financial, cost & utilization reporting at all levels + Supports Humana's Medicare Advantage product… more
- Humana (Montgomery, AL)
- … plan operations, such as provider relations, claims submission and payment, utilization management processes, behavioral health processes, and dispute ... part of our caring community and help us put health first** Humana Healthy Horizons is seeking a Senior...educational material, or trainings. + 2+ years of project management experience with mid-size projects. + 1+ years of… more