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By leading market level projects and strategies for provider engagement, this position will drive optimal performance on quality, risk adjustment, utilization management, financial performance, and membership growth.
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Data Management: Oversee the collection, processing, and utilization of data for training the chatbot, ensuring sensitivity and compliance with data protection regulations. Minimum of 5 years of experience in cloud infrastructure design and management, with a strong focus on Microsoft Azure.
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Analyze issues using enrollment, utilization, clinical, medical management, financial and other corporate data, and information from both modeled internal data as well as disparate internal and external sources.
$86,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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It involves the direction and oversight of all office space planning, utilization and management including, without limitation, the management of all associated construction and purchase of furniture and fixtures associated with small, medium, and large-scale office construction projects.
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Monogram's innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
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Demonstrates extensive abilities and/or a proven record of success assisting practice management, emphasizing partial or full management of client engagements involving the evaluation and enhancement of clients' indirect tax processes and/or systems to get better control over data and manage costs, including: State and local tax sales and use tax laws, regulations, policies and procedures.
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Understand medical billing, coding, insurance claims processing, and revenue cycle management. 1-2 years of member-facing experience in benefits management or insurance focusing on claims and collections.
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The team deploys the firm's capital for proprietary investment strategies and facilitates client transactions, investing in a broad array of products including corporate bonds, corporate loans, trade claims, post-reorg equities, litigation claims, structured products and public equities.
$100,000 - $165,000 a yearFull-timeExpandApply NowActive JobUpdated 2 days ago - UpvoteDownvoteShare Job
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The ideal candidate will have 15 or more years of experience as a lawyer and/or claim professional with a high degree of specialized and technical competence in litigation management and the handling of complex coverage issues, high exposure and/or long term exposure claims and coverage litigation.
$128,500 - $215,000 a yearFull-timeExpandApply NowActive JobUpdated Today - 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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Resilience is seeking a highly-motivated cyber insurance or privacy attorney to join itsglobal Claims and Incident Management team. Apply expertise in insurance contracts, claims investigations, and vendor management to recommend appropriate claim reserves.
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Recent experience in case management, home health, utilization review, and or unit clinical specialty required. Requires current case management certification from either CCM, ACMA or RN-BC or must achieve within two (2) years of hire as a Case Management Coordinator.
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NYSIG, including the duty to receive and investigate complaints from any source concerning allegations of corruption, fraud, criminal activity, conflicts of interest or abuse in the Gaming Commission.
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The Director, Market Development will play a pivotal role in shaping the future of international cross border payments and lead the charge in driving revenue growth, forging strategic partnerships, and expanding our footprint across global key markets.
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BEPA is seeking to hire Project Manager Interns for the Stormwater Permitting section located in Queens, NY. Under supervision, selected candidates will review construction plans for compliance with the rules and regulations for the management of stormwater from construction sites and maintenance of post construction stormwater management practices (SMPs), inspect sites for compliance with approved plans and in response to complaints from public.
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claims complaints utilization management jobs Company: Metroplus Health Plan in Newark, NJ
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