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Humana
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Trenton, New Jersey
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Experience with Pharmacy Benefit Manager, Pharmacy, or Healthcare data, in particular drug utilization ... company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for
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Humana
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Trenton, New Jersey
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medical interpretation and determinations whether services provided by other healthcare professionals are ... in teams focusing on quality management, utilization management, case management, discharge planning
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Highmark Health
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Trenton, New Jersey
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captures all inbound phone inquires for utilization management review from providers and pharmacies. The ... Highmark's Utilization Management system for Prior Authorization clinical review, status research, etc
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Humana
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Trenton, New Jersey
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, other healthcare providers, clinical group practice management.
Utilization management experience ... medical interpretation and determinations whether services provided by other healthcare professionals are
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Humana
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Trenton, New Jersey
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insurance, other healthcare providers, clinical group practice management.
Utilization management ... interpretation and determinations whether services provided by other healthcare professionals are in agreement
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Humana
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Trenton, New Jersey
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determinations whether services provided by other healthcare professionals are concordant with national ... , with prior experience participating in teams focusing on quality management, utilization management
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Humana
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Trenton, New Jersey
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insurance, other healthcare providers, clinical group practice management
Utilization management ... focusing on quality management, utilization management, case management, discharge planning and/or home
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Highmark Health
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Trenton, New Jersey
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then creates the case (data entry) in Highmark's utilization management system for clinical review ... utilization management system.
Use knowledge of process and judgement to evaluate identified cases that
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Humana
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Trenton, New Jersey
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interpretation skills, with prior experience participating in teams focusing on quality management, utilization ... , hospitals/ Integrated Delivery Systems, health insurance, other healthcare providers
Utilization
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Humana
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Trenton, New Jersey
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, Operations Management, Healthcare Administration, or related field. Eight (8) plus years business experience ... company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for
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Highmark Health
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Trenton, New Jersey
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, and then creates the case (data entry) in Highmark's utilization management system for clinical review ... utilization management system.
Use knowledge of process and judgement to evaluate identified cases that
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Humana
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Trenton, New Jersey
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of services provided by other healthcare professionals in compliance with review policies, procedures ... improving consumer experiences
Preferred Qualifications
Medical utilization management
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Sutherland Global Services
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Trenton, New Jersey
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Utilization Management Appeals
Prior Authorization Verification
Eligibility and Benefits
Status ... industries from financial services to healthcare, entertainment to retail, insurance to gaming, and
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Humana
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Trenton, New Jersey
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clinical services
Experience in utilization management review and case management in a health plan ... Humana insurance services and CenterWell healthcare services, we make it easier for the millions of
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CVS Health
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Trenton, New Jersey
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utilization management, quality management, network management and clinical coverage and policies ... .
Coordinates with the MCOs' care management staff and providers on medical services not included in the aligned
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Sutherland Global Services
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Trenton, New Jersey
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Utilization Management Appeals
Prior Authorization Verification
Eligibility and Benefits
Status ... financial services to healthcare, entertainment to retail, insurance to gaming, and everything in between
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CVS Health
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Trenton, New Jersey
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utilization of licenses and consumption-based services, drive initiatives to optimize expenditures. Identify ... provides management services. We do not discriminate in recruiting, hiring, promotion, or any other
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Evolent Health
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Trenton, New Jersey
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, including value-based care and utilization management- Required.
Experience in developing ... Services & Specialty Ops) and external partners. This will include conveying actionable insights that drive
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CVS Health
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Trenton, New Jersey
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, policies, and programs are comprised of utilization management, quality management, network management ... — our purpose sends a personal message that how we deliver our services is just as important as what we
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CVS Health
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Trenton, New Jersey
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utilization management, quality management, network management, clinical coverage and policies. The position ... — our purpose sends a personal message that how we deliver our services is just as important as what we
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CVS Health
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Trenton, New Jersey
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strategies, policies, and programs are comprised of utilization management, quality management, network ... — our purpose sends a personal message that how we deliver our services is just as important as what we
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Humana
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Trenton, New Jersey
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healthcare data including multi-level drill down assessment of key utilization and financial performance ... . Through our Humana insurance services and CenterWell healthcare services, we make it easier for the
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Intermountain Health
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Trenton, New Jersey
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, utilization management strategies and supply management strategies.
Serves as primary executive point of ... Intermountain Healthcare by coordinating complex and critical decision-making processes, implementation, and
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CVS Health
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Trenton, New Jersey
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strategies, policies, and programs are comprised of utilization management, quality management, network ... — our purpose sends a personal message that how we deliver our services is just as important as what we
...
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CVS Health
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Trenton, New Jersey
...
, policies, and programs are comprised of utilization management, quality management, network management ... — our purpose sends a personal message that how we deliver our services is just as important as what we
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HealthEdge Software Inc
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Trenton, New Jersey
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for Quality Assurance), CMS (Centers for Medicare & Medicaid Services), URAC (Utilization Review ... Overview
Position Overview:
Looking for a subject matter expert in the healthcare
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Oracle
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Trenton, New Jersey
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Energy & Utilities
Financial Services
Healthcare
Strategic Accounts/Pursuits
Direct ... and management of OCI resources, ensuring consistency and efficiency.
**Security and Compliance
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SHI
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Trenton, New Jersey
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, retaining, and leveraging Microsoft agreements to drive additional product sales and services opportunities ... needs as determined by SHI management.
About Us
Since 1989, SHI International Corp. has helped
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Elevance Health
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Trenton, New Jersey
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utilization of services, as appropriate, within benefits structure or through extra-contractual arrangements ... for overall management of member's case within the scope of licensure; provides supervision and
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Huron Consulting Group
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Trenton, New Jersey
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leadership in the markets they serve. We help healthcare organizations build innovation capabilities and ... , clinical services and technology is not enough to create meaningful and substantive change. To succeed long
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