and monitoring, productivity monitoring, FTE tracking and utilization, revenue tracking, and billing integrity. Works with director... heads to identify opportunities and develop plans for improvement. Reviews work processes across the Materials Management...
, the Company succeeds. This position is responsible for leading all aspects of Quality Management Clinical Operations... & Audit and Quality Management Performance Reporting, including HEDIS and STARS performance for Horizon Government Programs...
, clinical performance and management of the Case Management department and staff. Providing oversight of utilization review... management experience and a minimum of 3 to 5 years’ experience in utilization review using InterQual Criteria, and/or Millimam...
, clinical performance and management of the Case Management department and staff. Providing oversight of utilization review... management experience and a minimum of 3 to 5 years’ experience in utilization review using InterQual Criteria, and/or Millimam...
to budget package management and allocation, infrastructure of ROI comparison as well as related analysis, policy review related... management strategies to optimize budget allocation, traffic distribution, and resource utilization, driving growth...
, clinical utilization management and the transition to the next appropriate level of care. Responsibilities: Essential... to Utilization Management Plan. Integrates National standards for care management scope of services including: -Utilization...
, clinical utilization management and the transition to the next appropriate level of care. Responsibilities Essential... to Utilization Management Plan. Integrates National standards for care management scope of services including: -Utilization...
with supporting the financial, administrative and operational management within one clinical department. Translates the objectives... volume academic environment. 2. Two (2) years of healthcare management/supervisory experience. CORE DUTIES...
Operations Management team. You will oversee planning and resource utilization, set objectives, drive performance development... Director, Country Operations Management (AD COM), you will report to the Director, Study Start-Up and Site Partnership and play...
SW/RN Case Manager activities. The CMA will work side by side with the SW/RN Case Management to assist with discharge... planning and utilization review activities. Qualifications Bachelor's degree (BA or BS) in a healthcare related field...
Job Summary: Directs risk management programs by contributing to proactive planning and strategy for audits... and analyses to evaluate risk management programs. Provides thought leadership on reporting and specialized data analysis...
the highest clinical skills and judgement. Management of the caseload assigned by Manager includes: coordinating health..., provider's utilization review vendors, members, Call Center, claims staff, Health Homes Program (HHP) eligibility or other data...
Medical Management Services review Medicare Managed Care plans and receive case reviews via fax and a non-clinical team data..., provide case management, care coordination and perform utilization management duties within the appropriate time period...
SW/RN Case Manager activities. The CMA will work side by side with the SW/RN Case Management to assist with discharge... planning and utilization review activities. Qualifications Bachelor's degree (BA or BS) in a healthcare related field...
/chemical dependency, orthopedics, general medicine/surgery. Or, 4 years utilization review/case management/clinical...Summary We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina...
summary and not all inclusive): Conduct utilization management reviews Conducts in person screenings and needs & means... as appropriate. Facilitate and supervise needs and means assessments conducted by Case Managers. Review case management...
any utilization management review activities which require interpretation of clinical information. Minimum Requirements: Requires... clinical information regarding case and determines appropriate area to refer or assign case (utilization management, case...
from an accredited school of nursing Req 3 years Clinical experience as a Registered Nurse Req 2 years Utilization Review and Case... and communication with key stakeholders including: surgery schedulers, providers, hospital financial counselors, hospital utilization...
for utilization review management. Estimated pay range for this position is $19.44 - $23.52 / hour depending on experience...Is responsible for the coordination of information between the Care Management Department and Third Party Payors...
insights on asset utilization, compliance status, and cost savings opportunities. Software Asset Management (SAM.... Generate routine and ad-hoc reports on software utilization, compliance status, and cost savings opportunities for management...