Manager Utilization Management Jobs in Raleigh, NC

Experience: Prior managed care or utilization management experience preferred - retail and hospital pharmacists with strong clinical and documentation skills are encouraged to apply. * Skills:

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 ...

Prior authorization, utilization management, or managed care preferred - retail or hospital pharmacists with strong clinical judgment are encouraged to apply. * Skills: Excellent clinical review ...

Utilization management experience in Cardiovascular or Radiology. * Highly organized and analytical with strong attention to detail. * Ability to manage multiple priorities while maintaining ...

Utilization management experience in Cardiovascular or Radiology. * Highly organized and analytical with strong attention to detail. * Ability to manage multiple priorities while maintaining ...

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

As a Vascular Surgery, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients' lives, in a non-clinical ...

As a Cardiology, Field Medical Director you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non-clinical ...

Financial Management & Advanced Analytics * Analyze claims/utilization trends, Rx spend, high-cost claimants, and program/point-solution outcomes; identify cost drivers and mitigation levers. * Lead ...

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)

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

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

Founded in 1993, AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support cost-effective quality care ...

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 ...