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The Pharmacy Prior Authorization Specialist will ensure patients receive the medication that requires pre-authorizations from insurance carriers by receiving prescriptions, addressing and rectifying rejected claims and conducting necessary third party authorization requests.
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We are actively hiring for a Third Party Risk Management Specialist. Reporting and Communication: Prepare and present reports on third-party risk management activities to senior management and relevant stakeholders.
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The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner. The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
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8 years of operations experience in a relevant functional area to include financial services, Fraud, AML, compliance, risk, audit, third party risk management or other related operational areas that support fraud risk management initiatives within the business.
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As a Financial Crimes Member Advocacy Specialist, you will play a key role in shaping, executing, and monitoring the member advocacy strategy, focusing on fraud prevention, education, and internal team alignment.
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Job Description Reporting to a Manager, Third Party Portfolio Management, the Third-Party Portfolio Risk Manager (TPPRM) partners with Product Service Owners (PSOs) in assigned Business Lines (BL), BL Chief Risk Officers (CRO) staff, Risk/Compliance/Audit (RCA) Managers, Procurement Partners, Law Division, Technology and Information Security teams to implement and drive the end-to-end execution of third-party risk management lifecycle.
$116,600 a yearFull-timeExpandApply NowActive JobUpdated 19 days ago - UpvoteDownvoteShare Job
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Assist with process improvement and discussions related to third-party risk management solutions. Build communication and escalation plans related to third-party risk management activities across National IT.
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Senior Third Party Risk and Controls Management Engineer. Cloud security, identity and access management, third party risk management, vulnerability management. The third party risk and controls management analyst will be responsible for conducting deep dive technical risk reviews of client's highest risk suppliers.
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Anticipate, initiate, and establish a discharge plan for patients with post-acute care needs, collaborating with the physician, nurse, and other health care providers, the patient, their family/primary caregiver(s), third-party payers, and employer following established clinical guidelines, standards, and pathways.
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Christiana Care includes an extensive network of outpatient services, home health care, urgent care centers, three hospitals (1,299 beds), a free-standing emergency department, a Level I trauma center, a Level III neonatal intensive care unit, a comprehensive stroke center and regional centers of excellence in heart and vascular care, cancer care and women’s health.
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Christiana Care - Wilmington Hospital currently recruiting a Weekend RN Case Manager with experience in Transitional Care or Discharge Planning in an Acute Care Hospital Setting. Identify patients who have post-acute care, placement, and complex discharge planning needs based on a comprehensive assessment that includes physical, as well as psycho-social factors/needs.
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Essential Functions: Serves as Senior Risk Officer, responsible for the development, management and oversight of the Bank’s Third Party Risk Management program, ensuring the program remains up to date based on most current regulatory guidance/standards.
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ADARs will also be required to coordinate and communicate cross-functionally within NPC (e.g., Patient Support Center, Customer Engagement, Marketing, Market Access, Public Affairs, State & Government Affairs, Trade, Specialty Pharmacy Account Management, and other applicable third-party affiliates.
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Working with various Second and Third Line groups and related partners (Operational Risk Management, Enterprise Risk Management, Third-Party Risk Management, Compliance, Legal, Internal Audit, and more), review and determine when new legislation, regulations or risk management frameworks are applicable to department operations; and work with unit Operations Managers to ensure business units implement necessary policies, processes and procedures to comply therewith.
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Report any necessary major costume maintenance and repair issues for consideration for third party repairs in a timely manner. Maintain costume character standards as set forth by Warner Bros. and DC Comics.
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third party operations specialist call center jobs Title: specialist senior
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