of clinical experience and/or utilization review experience. Current active, valid and unrestricted LPN/LVN license or RN license...Anticipated End Date: 2026-02-13 Position Title: Medical Management Clinician Job Description: Medical Management...
for utilization review/management. May be responsible for developing and implementing programs to improve quality, cost, and outcomes... years utilization management review experience preferred. Knowledgeable of Medicaid/Medicare policies and guidelines...
Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed... and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the...
, including support of variance analysis. Assist in the continued improvement, utilization and management of the capital... director and executives including progress towards meeting annual targets. Review monthly capital forecasts with each of the...
. Assists with concurrent and retrospective utilization review activities including denials and appeals. Works with physicians... to conduct peer review with payer medical director when indicated. Ensures clinical updates are provided to all insurance payers...
’s COOP instruction and as determined by the CCPA Director, be prepared to deploy toalternate site COOP locations to support..., including layout, color scheme, typography,and overall visual style for review by leadership and stakeholders. Responsive...
Manager will be responsible for overseeing the planning, creation, and management of CCPA's English and foreign language... of Responsibility. Continuity of Operations: As specified by the Command’s COOP instruction and as determined by the CCPA Director...
Preferred Qualifications: Bachelor's degree 2+ years of experience in utilization management or case management in a managed... and any associated case review and documentation. You'll enjoy the flexibility to work remotely * from anywhere within the...