Utilization Management - 35+ job offers

Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities, and members. Revi

Role Description Perform prospective, concurrent, and retrospective reviews of inpatient, outpatient, ambulatory and ancillary services to ensure medical necessity, appropriate length of stay, the intensity of service, and level of care, including appeal requests initiated by providers, facilities,

Description Role/ Responsibilities • Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking • Monitor transactions with an ongoing basis and take corrective steps where necessary or make incremental imp

Description Role/ Responsibilities • Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking • Monitor transactions with an ongoing basis and take corrective steps where necessary or make incremental imp

Description Role/ Responsibilities • Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking • Monitor transactions with an ongoing basis and take corrective steps where necessary or make incremental imp

Description Role/ Responsibilities • Serves as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking • Monitor transactions with an ongoing basis and take corrective steps where necessary or make incremental imp

Role Description Professional interaction with Nurses, Insurance Adjusters and other medical staff In-take / Data Entry of UM referrals and case assignment Evaluate faxes received for identifying information and through thorough research in the l system; link files as needed to opened requests that

Role Description Who We Are: UST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solutions manage complex admin tasks, allowing our customers to prioritize members well-being. With our commitment to simplicity, honesty, and le

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, yo

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, yo

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, yo

About us For 38 years, Omnicom Media Group (OMG) has been a global network of leading marketing communications companies with headquarters in the United States and multiple agencies in regions such as APAC, EMEA, and LATAM. Our portfolio provides the best talent, creativity, technology, and innovati

It's more than a job When you work in Freight Logistics and Operations at Kuehne+Nagel, you play a key role in optimising processes and ensuring that inventory and shipments move efficiently. But that is not all. Your work also helps ensure that vital medicines reach patients on time and supports ot

MicroSourcing

*Discover your 100% YOU with MicroSourcing!** *Position:** Utilization & Denials Management Manager *Location:** Taguig *Work setup & shift:** Onsite | Night shift *Sign-on bonus: 100,000\*** *Why join MicroSourcing?** *You'll Have** Competitive Rewards: Enjoy above-market compensation, heal

Carelon Global Solutions Philippines

Job Description: Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of

Carelon Global Solutions Philippines

Job Description: Responsible for collaborating with healthcare providers and members to promote quality member outcomes, to optimize member benefits, and to promote effective use of resources. Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of

The Clinical Consultant provides clinical and operational support as a U.S. Healthcare Subject Matter Expert, providing various clinical support services and operational guidance for business processes, to include Case Management, Utilization Management, Clinical Coverage Preservice, Claims and Appe

2X

The Practice Head is accountable for the commercial performance, delivery excellence, talent strategy, and market positioning of a 400-person consulting practice spanning Marketing Operations and Data & Analytics. The role combines full practice performance with large-scale organizational leadership

Infinit-O

Infinit-O is the trusted, customer-centric, and sustainable leader in Business Process Optimization. We empower finance and healthcare organizations to thrive in a digital-first world by combining specialized industry expertise and innovative technology for 20 years. We navigate complex industry lan

Sagility combines industry-leading technology and transformation-driven BPM services with decades of healthcare domain expertise to help clients draw closer to their members. The company optimizes the entire member/patient experience through service offerings for clinical, case management, member en