Auditor, Delegate UM/CM

Alignment Health is breaking conventional health care by serving seniors with chronic illnesses. This role supports oversight audits of delegated entities by conducting Utilization Management (UM) and Case Management (CM) audits aligning with enterprise audit strategy. · Key resp ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

We're building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health, you'll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safe ...

This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning and identifying alternate treatment programs; · Registered Nurse (RN) with current, valid, unrestricted license to practice in state of ...

This position is responsible for performing concurrent review in accordance with approved departmental guidelines; performing discharge planning and identifying alternate treatment programs; conducting episodic case management, consulting and collaborating with providers, members ...

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team ...

Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range display ...

Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range display ...

The Director of Medical Management will be responsible for leading and overseeing the Blue Zones Health clinical operations. · ...

The Director of Medical Management will be responsible for leading and overseeing the Blue Zones Health clinical operations, · with a primary focus on utilization management, care management, · and regulatory audit readiness. · This role ensures that medical management programs a ...

Job Description · This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requiremen ...

JOB DESCRIPTION · This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requiremen ...

· Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range disp ...

^Remote Work · Must be authorized to work in USA with a valid VISA/GC/USC · Job Description: · We are seeking an experienced Epic Tapestry Utilization Management Analyst to design, build, optimize, and support UM processes focused on authorizations and referrals. The ideal candid ...

Position Description · Base pay is influenced by several factors including a candidate's qualifications, relevant experience, and anticipated contributions to meet the needs of the business, along with internal pay equity and external market driven rates. The salary range display ...

· JOB SUMMARY · The Delegation Oversight Letters Analyst is responsible for supporting delegated oversight compliance by developing, implementing, maintaining, and monitoring Utilization Management (UM), Case Management (CM), and Medical Management correspondence templates in ac ...

Description · JOB DESCRIPTION  · This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards ...

JOB DESCRIPTION · This position is responsible for continuous quality improvements within the Delegation Oversight Department. Oversees delegated activities to ensure compliance primarily with NCQA, CMS and State Medicaid requirements including delegation standards and requiremen ...

Dice is the leading career destination for tech experts at every stage of their careers. Our client, C9xperts Corp., is seeking the following. Apply via Dice today · Role: Tapestry UM Analyst Job Description: We are seeking an experienced Epic Tapestry Utilization Management Anal ...