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Job Summary The Manager, Health Plan Business Operations for Grievances and Appeals is responsible for managing health plan operations and regulatory compliance with emphasis on grievances and appeals, utilization management and claims processing.
$86,756 - $130,134Full-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Performs prospective and/or retrospective drug utilization review. Clinical Pharmacy Manager, Registered Pharmacist, Pharm D, Hospitals, LTAC, Transitional Care Hospitals, Acute CareQualificationsBachelor’s Degree in Pharmacy or PharmD from an accredited school of pharmacy.
ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Reviews medical files and provides recommendations for utilization review, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health and workers’ compensation claims.
RemoteExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Thorough knowledge of customer service, utilization review or claims processing practices in a managed care environment and operation of office equipment such as a personal computer. Assist in activities related to the medical and psychosocial aspects of utilization and coordinated care.
ExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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Utilization of Indio for all supplemental applications, schedule reviews for renewals and quoting purposes. Create renewal submission once review is finalized in AMS for AM/AE to distribute to market.
ExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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The ROSA Zone Program Development Director builds successful programs by aligning with key stakeholders including surgeons, staff , executives and local implant teams to drive system utilization with the ROSA Robotic Knee Platform.
ExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Review of MOL/RM for utilization of internal inventory issuing to job lot. Known for its stunning architecture, award-winning dining, professional sports teams, and unparalleled views, it offers a great living environment.
Full-timeExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
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Collaborate monthly with market NPs on high cost patients, utilization review, intake reviews. Review admissions and utilization data to identify patients for program inclusion in transitions and high risk care programs.
ExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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Meets (when required) with Concentra Physician Review Medical Director to discuss quality of care and credentialing and state licensure issues. Relying on clinical background, reviews health claims providing medical interpretation and decisions about the appropriateness of services provided by other healthcare professionals in compliance with Concentra Physician Review policies, procedures, and performance standards and URAAC guidelines and state regulations.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Experience with staff orientation, onboarding, clinical chart review, utilization review reporting, and quality improvement. Experience with staff orientation, onboarding, clinical chart review, utilization review reporting, and quality improvement.
ExpandApply NowActive JobUpdated 9 days ago - UpvoteDownvoteShare Job
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Participates in quality assurance, utilization management, and peer review programs to ensure high quality, cost-effective services. Experience, preferably in the Skilled Nursing/Post-Acute care and/or Hospitalist setting.
Full-timeExpandApply NowActive JobUpdated 23 days ago - UpvoteDownvoteShare Job
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We are seeking a Wound Care physician to join a growing physician owned group working in the SNF, Long Term Care, and ALF settings. We get more sunshine than Miami, but you can also enjoy skiing and hiking in the mountains.
$150ExpandApply NowActive JobUpdated 3 days ago - UpvoteDownvoteShare Job
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Manage, review and assist with providing data to multiple Regional Directors and other operational personnel on operating costs data, including productivity reporting, equipment & labor utilization, per diem spend, and other back office and operational indirect expenses.
ExpandApply NowActive JobUpdated 15 days ago - UpvoteDownvoteShare Job
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Participate in patient care planning and utilization review meetings. Provides professional treatment while using therapeutic techniques for the rehabilitation of patients with speech, language, hearing, oral motor, swallowing and cognitive disorders.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Enhances the quality of patient management and satisfaction, to promote continuity of care and cost effectiveness through the integration of functions of case management, utilization review and management, and discharge planning.
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utilization review jobs in Denver, CO
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