- UpvoteDownvoteShare Job
- Suggest Revision
Director Care Coordination- Major Responsibilities Criteria A: Establishes and coordinates communication with all Utilization Regulatory Agencies i.e. Qualidigm, NGS, etc., State and Third Party Payers to address Utilization Management Issues and Denials.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Collaborate with other organizational departments responsible for functional aspects of the HIV Special Needs Plan, including, but not limited to Integrated Care Management, Behavioral Health, Managed Long-Term Care, Utilization Management, Quality Management, Credentialing, Regulatory Affairs, Compliance, Corporate Affairs, Provider Network Operations, Medicare Services, Information Systems, Finance, Claims, and Member Services and Eligibility.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Position Overview Under the direction of the Medical Director for Partnership in Care (PIC), the Director of Care Management (PIC) provides clinical and administrative direction to Partnership in Care care management staff who are focused on providing high quality clinical support and health education to members with HIV and those at risk of HIV infection to ensure these members receive the best possible care and achieve optimal health and wellness.
$150,000 - $157,236 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
- Suggest Revision
Provide expert guidance and training to stakeholders on insider risk management best practices and the utilization of Proofpoint ObserveIT. Stay abreast of the latest insider risk trends, technologies, and regulatory changes to continuously enhance the institution's insider risk posture.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Foreign Medical Graduate; and, two (2) years of medical records review or utilization and case management experience; or. Clinical Document Specialist (CDIS): under the supervision of the leadership of the Director of Health Information Management or designee is responsible to review medical records for appropriate documentation that will assist to enhance appropriate documentation that will enhance reimbursement, and improve documentation in order to be in-compliance with regulatory agencies and reduce denials.
Full-timeExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Conduct utilization review, incident management and review and quality assurance reviews. The Clinical Supervisor is responsible for maintaining OASAS regulatory compliance and assuring that programs operate in accordance with VIP Community Services organizational standards.
$70,000 - $75,000 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Under general supervision of the Director of Case Management, the Utilization Review Nurse provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient services.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Supports Utilization Management (UM) department staff and nurse Care Managers on concurrent review and preauthorization referrals and ensures that members receive appropriate services consistent with their benefits, regulatory requirements, and established clinical criteria.
$175ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Software and Systems group within Tax Reporting & Strategy (TRS) offers management consulting services to clients and to their large corporate tax functions, by monitoring and analyzing legislative and regulatory tax developments, developing strategies in anticipation of tax law changes and regulatory developments, analyzing the economic impact of tax legislation and federal budget proposals, and addressing technology needs for tax function effectiveness.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Monitor risk taking and limit utilization; engage in breach remediation, and escalation workflow, propose appropriate risk treatment across internal stress testing and regulatory reporting requirements for existing and new business activities.
$110,000 - $140,000Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The Biosolids Practice Leader will lead the development and implementation of business strategies across North America in coordination with Wastewater Market Sector leadership and other technical Business Class Directors (e.g. wastewater treatment, biogas utilization, conveyance, asset management, etc.
$130,410 - $242,190 a yearFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
- Suggest Revision
Familiarity with utilization management/case management. The Managed Care Coordinator (MCC) is expected to insure high quality, cost-effective care and services for Elderplan/HomeFirst members through support of professional Care Management activities.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
The position supports all aspects of care coordination for our Medicaid, and/or dual product members in compliance with all departmental and CMS/DOH regulatory requirements. The position requires excellent communication and organizational skills to facilitate superior care management and to act as a liaison between the members, the care management team, and the vendors.
ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
If acting in the capacity as a clinical pharmacist the incumbent may also review UM requests; provide consultation into the case and disease management identification process, and consult with the Organization's Associate Medical Directors and Medical Directors when appropriate, follow-up on appeals in accordance with our regulatory guidelines.
Full-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Expertise in utilization management including standard utilization and financial metrics. Expertise in population health management with application to physician practice improvement.
ExpandApply NowActive JobUpdated Today
utilization management regulatory jobs in Jersey City, NJ
FEATURED BLOG POSTS
10 Practical and Effective Strategies to Persuade Anyone of Anything
Learning how to persuade people is like a key that can unlock any door. Acing the interview for the job of your dreams. Getting the best deal on a new car. Closing a sale with a skeptical customer. All of these wins require a level of persuasiveness.
When Rage Applying Strikes: How to Identify Unserious Candidates
As the job market remains highly competitive, we have seen a surge in "rage applying." This is when candidates apply to multiple jobs, often without considering whether they are truly interested in the role. Rage applying goes hand-in-hand with quiet quitting. Often, employees want to entertain the thoughts and feelings of leaving their job, but they aren't necessarily serious about leaving yet. Meanwhile, other employees engaging in this trend are actually trying to find a better role. As a recruiter, it can be hard to identify who are the real applicants in a sea full of quiet quitters, but understanding rage applying and identifying red flags will certainly help.
How to Increase Job Ad Exposure
In today's competitive job market, writing quality job ads is critical for attracting top talent to your organization. While networking and candidate referrals are prime real estate for finding qualified candidates, nothing beats the tried-and-true method of writing an extraordinary job ad. But while writing a great job ad is the first step, what's more important is increasing visibility. You could have the most detailed, well-written ad on the internet, but if no one sees it, then you are wasting time (and potentially money!). Employers often believe that job boards are the root of the problem, but you can learn how to increase job ad exposure by tweaking a few steps of your recruitment process.
How to Navigate Hiring Out of State
The job market has shifted significantly in recent years. The accelerated adoption of technology has not only pushed many companies into remote working arrangements but also increased the availability of supporting tools and technologies (i.e., video conferencing and collaboration software).
Building a Candidate Pipeline Through Internships
Building a candidate pipeline through a great internship program for local college students and recent graduates at local universities is a great and cost-effective way to attract and retain top talent. By offering meaningful and impactful work experiences, regular feedback, coaching, and mentorship, you can create a positive internship experience that will make your organization a sought-after destination for future employees. This not only benefits the organization in the short-term but also in the long-term, as you'll have a pool of well-trained and experienced candidates who may be interested in full-time employment once they graduate. Furthermore, building relationships with local universities and college students can increase brand awareness and build a positive reputation for your organization in the local community.
Hiring Transparency
Transparency in hiring refers to the open and honest communication and information sharing that takes place between employers and job candidates. It encompasses all aspects of the hiring process, from posting job descriptions to providing feedback on performance during and after the interview process. In today's job market, hiring transparency has become increasingly important for both employers and candidates alike.
Recruitment strategies that are weird, but actually work
In the current candidate-driven job market, recruiters are looking for unique ways to attract talent. Some have resorted to even (dare we say it?) recruitment strategies on the border of weird and wacky. What can we learn from the unusual recruitment tactics that are being used and actually getting results? Here’s a rundown of some unique recruitment strategies that actually work.