Jobs by SimplyHired
Viewing 11 - 20 of 83 jobs
Coordinates, directs, and manages the activities of the department and the quality management program. Responsible for the analysis of the quality of member care received and for the development of plans and programs to support continuous...
Responsible for analyzing, reporting, and developing recommendations on data. Uses multiple sources of data, analyzes trends, reconciles data, and identifies areas for improvement. Under general supervision, develops and analyzes...
Performs review activities as outlined following rules established by the peer review organization, Medicare, and other third-party payers. Coordinates utilization functions and personnel to comply with procedures and regulations.?...
Assist members, prospective members, providers, and/or external vendors with member health plan benefit information, claim status, medical authorizations, health plan documents, and/or product information over the phone. Calls may be...
Performs routine clerical support for functional groups such as copying, distributing mail, performing simple calculations, data entry, and maintaining records and files following standard procedures. May sort or distribute correspondence,...
Responsible for non-clinical administrative, data management, and support services of a health services functional area. Support may be complex, detailed, technical and confidential nature. Prepares correspondence and reviews and edits...
according to the Case management Program. Manages HealthSpring members with varying benefit plans and program ... members and collaborate with hospital staff and HealthSpring staff for effective discharge planning...
Responsible for application systems analysis and programming activities for a group or section. Responsible for feasibility studies, time and cost estimates, and the establishment and implementation of new or revised applications systems...
Responsible for providing timely and accurate guidance to health plan departments related to federal rules and regulations. Acts as a liaison between the health plan and Centers for Medicare and Medicaid Services (CMS). Review marketing...
Job Description: Under the general supervision of the director of Utilization Management, the position is responsible for the ongoing assessment, planning, and evaluation of clients in the alternative case management program. The...
To further refine your results, please use the advanced filters below.