- Humana (Lansing, MI)
- …for our provider partners and reducing unnecessary costs from the healthcare system. The Utilization Management Strategy Lead role works closely with ... and providers, (3) achieve these outcomes while driving operating efficiency. The Utilization Management Strategy Lead will bring deep expertise in… more
- Point32Health (Canton, MA)
- …at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Director, Utilization Management is responsible for directing, leading, and ... modifying the business processes and operations for all levels of utilization management review (ie, Precertification and Intake Services, Inpatient &… more
- Commonwealth Care Alliance (Boston, MA)
- …implementation of successful methods for working with providers. Ensures integration of utilization management functions with network strategy , vendor ... This Role is Important to Us:** The Director of Utilization Management leads and manages all ...and conflict resolution. + Proven ability to influence and lead ; well-developed teambuilding skills, unquestioned integrity, and the experience,… more
- The Cigna Group (Franklin, TN)
- The Chief Medical Officer (CMO) Utilization Management will develop and manage efforts to improve and maintain cost and utilization trends. Responsible for ... departments of insurance, and similar accreditors/regulators for the performance of all utilization management (UM) programs across the enterprise. The CMO is… more
- Elevance Health (Tampa, FL)
- …of Florida. + Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; or any combination of education ... Senior RN Utilization Review/ Management (Acute InPatient) JR116937 **Location:**...creating a culture that is designed to advance our strategy but will also lead to personal… more
- Elevance Health (Tallahassee, FL)
- ** Utilization Management Representative II** **Location:** Must live within 50 miles of a Florida PulsePoint. The ** Utilization Management Representative ... eligibility information. + May act as liaison between Medical Management and internal departments. Responds to telephone and written...creating a culture that is designed to advance our strategy but will also lead to personal… more
- Elevance Health (Columbus, GA)
- **Title: Utilization Management Representative I** **Location:** This position will work a hybrid model (remote and office). Ideal candidates will live within 50 ... miles of one of our PulsePoint locations. The ** Utilization Management Representative I** will be responsible...creating a culture that is designed to advance our strategy but will also lead to personal… more
- Elevance Health (Tampa, FL)
- …At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. ... for people enrolled in Medicaid and/or Medicare programs in Florida. **Licensed Utilization Review Ld** **Location:** This is a remote position. The selected… more
- Humana (Nashville, TN)
- …for key Medicaid programs and subpopulations. Areas of focus include Care Management , Quality Improvement, Utilization Management , Population Health, Social ... health first** Humana Healthy Horizons is seeking a Capture Lead , Clinical & Population Health Strategy , to...Medicaid Managed Care Organization (MCO) focusing on Medicaid clinical strategy and population health management strategy… more
- Bristol Myers Squibb (Princeton, NJ)
- …ensuring contribution to improving impact and business results and performance. The digital strategy lead will drive the continuous evolution of the Intelligent ... and development of various digital use cases across Procurement + Coordinate with SS&P Strategy & Performance lead to prioritize funding for digital / technology… more