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Utilize customer relationship management software (CRM) and other tools to review activities, drive utilization and provide feedback to achieve optimal sales performance and productivity.
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Knowledge of National Committee for Quality Assurance (NCQA) / Utilization Review Accreditation Commission (URAC) standards. Under general supervision of the Program Director and in collaboration with the administrative team and Medical Director, the Quality Manager oversees the department responsible for internal and external Quality Review processes in accordance with the goals of the Colorado HCPF Utilization Management Contract.
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EzURS.com Inc., has an ongoing need for Physician Consultants to perform a wide variety of world-class utilization review, disability, peer reviews products in multiple lines of business including health, workers compensation, and auto liability.
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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.
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Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial health insurance. 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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Board certified MD, DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality assurance and the development of policies that support these services.
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Carries out hospital programs and principles of utilization review in compliance with hospital policies and external regulatory agencies Peer Review Organization (PRO), The Joint Commission (TJC, and multiple payer defined criteria for eligibility.
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Dane Street is an Independent Review Organization and a national provider of Utilization Review services (among other offerings) and we are expanding our physician panel resulting in opportunities for non-traditional physician work and supplemental income.
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Our Commitment to Diversity and Inclusion
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When deemed necessary and appropriate within a market, the Dental Director will focus on the proper provision of medically necessary covered services for enrollees and remain closely involved in the monitoring of program integrity, quality, utilization management, and utilization review.
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Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQNational Committee for Quality Assurance, and ERISEmployee Retirement Income Security Act of 1974.
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Gather information from utilization review and managed care organizations to develop stop-loss pricing. Gather information from utilization review and managed care organizations to develop stop-loss pricing.
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Some of the most important skills include patience, excellent communication, ICD coding, critical thinking, utilization review and stress management. Specialty: Emergency room, oncology, intensive care, psychiatry, telemetry, labor, and delivery, etc.
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Review of investment portfolio activity in the PAM for Investments (PFI) system, the investment datamart and utilization of DIGITS reporting tool. PFI, Essbase, & BlackLine experience preferred.
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The Moehl Millwork Sales Manager is responsible for providing strategic leadership by driving sales and profitability in order that sales, profitability, and other objectives are met. Collaborate and coordinate with marketing to develop programs, promotions, collateral materials, and sales tools, implementing a regular cadence of promotions that drive incremental sales.
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utilization review jobs in Des Moines, IA
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