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Minimum of six (6) years in a managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals.
$38.37 - $48.93 an hourFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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The Grievance Resolution Specialist coordinates the Grievance and Appeal resolution process, responds to verbal and written Grievances and Appeals from members and/or providers relating to member eligibility and benefits, contract administration, claims processing, utilization management decisions, and pharmacy and vision decisions.
$24.52 - $31.04 an hourTemporaryExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation.
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The care management system provides critical, core health plan functionality including utilization management, transportation authorization, care management, population health, appeals and grievances, analytics and reporting.
ExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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The Field Reimbursement Manager will be responsible for the management of defined accounts in Urology and Oncology area, specifically supporting our client’s product. The Reimbursement Manager will also work on patient level reimbursement issue resolution, and thus will need access to be knowledge of and have had experience with patient health information (PHI), navigating access issues, and working with payer and NCCN guidelines for product utilization.
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Support patient access assistance from prescriber decision through to fulfillment, supporting the entire Reimbursement journey through payer prior authorization to appeals/denials requirements procedures and forms.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Must have general payer policy knowledge including public & private payers, foundational knowledge of benefit verifications & prior authorization/pre-determination requirements (including appeals/exceptions), & knowledge of access & reimbursement processes within various sites of care.
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The Utilization Management Coordinator coordinates and monitors daily activities of the utilization management functions of the Care Coordination Department, ensuring the appropriate allocation of hospital resources while maintaining quality of patient care.
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Demonstrated level of proficiency with support technology (e.g., PC, tablet, & Customer Relationship Management (CRM) tools) The Field Reimbursement Manager will execute the collaborative territory strategic plan through partnership with internal and external stakeholders, including acting as an extension of patient support program and in other collaboration with other partners.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. The Medical Director conducts Utilization Management of the care received by members in an assigned market, member population, or condition type.
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Establish and maintain knowledge on the local and national payer landscape, including Specialty Pharmacy and Utilization Management criteria for Dupixent. · Support field in education of office personnel on prior authorization and appeals processes, reimbursement support through Dupixent MyWay, free drug programs and financial assistance programs.
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Serves as a clinical resource for Utilization Management, Chief Medical Officer, Physicians, and Member/Provider Inquiries/Appeals. Strong experience with appeals reviews and/or utilization management working on the manage care side.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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May also engage in grievance and appeals reviews. Knowledge of the managed care industry including Medicare Advantage, Managed Medicaid and/or Commercial products, or other Medical management organizations, hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers, clinical group practice management.
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The RN Utilization Management (RN UM) functions as a support liaisons for a variety of UM functions which may include: the e-TAR process, denials management, and the UM process. Other duties may be assigned such as denials management and appeals in lieu of other UM duties.
Full-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Experience working with Case managers or Care managers on complex case management, including familiarity with social determinants of health. Become a part of our caring community and help us put health first.
ExpandApply NowActive JobUpdated 7 days ago
utilization management appeals jobs
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