Manager Utilization Management Jobs in Raleigh, NC

Experience in Utilization Management processes BSN strongly preferred . * Knowledge of Microsoft Windows operating system and proficiency with applications such as Microsoft Office. * Knowledge of ...

UR contacts external case managers/managed care organizations for certification of insurance ... Previous utilization review experience in a psychiatric healthcare facility preferred. License:

Demonstrated success in developing and executing sourcing strategies across complex, multi-category healthcare environments including healthcare analytics, utilization management, care management ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Monitor Utilization Management and Case Management activities through the development of KPIs and benchmarks (i.e. member engagement rates, readmissions, preventable hospitalizations, ER utilization)

Maintains and updates JIVA automation code sets, rules, and configurations to support accurate claims processing, utilization management workflows, benefit administration, and medical policy ...

Maintains and updates JIVA automation code sets, rules, and configurations to support accurate claims processing, utilization management workflows, benefit administration, and medical policy ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

The incumbent must possess medical management/clinical decision-making skills and sound skills in ... Utilization and Quality Management/Outcomes experience preferred. Previous work experience with a ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Monitor/respond to health plan coverage decisions (formulary, utilization management, clinical policy) and coordinate rapid responses. * Drive specialty pharmacy (SP) pull-through performance: manage ...

Collaborate with Utilization Management to ensure staff and sites are properly credentialed * Maintain credentialing systems (CAQH, NCTracks, commercial payers) and ensure data accuracy * Follow up ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Collaborate with Utilization Management to support payer negotiations, reduce denials, and promote appropriate resource use. Documentation & Compliance * Maintain timely, accurate documentation of ...

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. Maintain timely documentation of assessment findings ...

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. Maintain timely documentation of assessment findings ...

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. Maintain timely documentation of assessment findings ...

Work with Utilization Management partners to provide information and feedback that will enhance negotiations and denial prevention with payers. Maintain timely documentation of assessment findings ...