- Humana (Nashville, TN)
- …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
- HCA Healthcare (Nashville, TN)
- …assessments of focused topics within HCA Healthcare hospitals/ASCs including credentialing, utilization management , peer review, medical staff and board bylaws, ... that invests in you as a Director Regulatory and Accreditation WFH? At HCA Healthcare, you come first. HCA...division vice president, quality or director, quality and risk management . Up to 75% TRAVEL REQUIRED Major Responsibilities *… more
- Amazon (Nashville, TN)
- …Registration, Professional Engineer Registration, CEM and/or other building professional accreditation - Experience in building portfolio management and/or ... estate strategies and operations across our global fulfillment network. As a Senior Carbon Modelling Lead within the Global Realty Sustainability & Renewable Energy… more
- Molina Healthcare (Bowling Green, KY)
- …continuous quality improvement of the provider database, compliance with regulatory/ accreditation requirements, and Network Management business operations. ... improvement initiatives as it pertains to other provider network management areas. **KNOWLEDGE/SKILLS/ABILITIES** + Bridge communication and collaboration between… more
- Evolent (Nashville, TN)
- …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 (Nashville, TN)
- …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 (Nashville, TN)
- …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
- Evolent (Nashville, TN)
- …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 (Nashville, TN)
- …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
- Evolent (Nashville, TN)
- …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