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Principal Accountabilities: • Evaluates clinical information submitted by providers against plan review criteria and benefit guidelines. • Utilizes clinical information to determine if criteria for medical necessity…
Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care…
TITLE: REMOTE CASE MANAGER - INTEGRATED CARE. LOCATION: FORT LAUDERDALE, FL. 33304. DURATION: 6+ MONTHS. LICENSE : LCPC, LCSW OR RN. THE RN REQUIRES A MIN. BACHELOR’S DEGREE. ALL OF OTHER LICENSES REQUIRES A MASTER’S…
The successful candidate will provide meaningful contributions toward commercial manufacturing support, process monitoring, technology transfer and process validation activities. The successful candidate will have a…
Job Description: This position requires the Pharmacy Technician to review, deny or approve and communicate decisions for prior authorization pharmacy requests according to clinical guidelines. Evaluates and authorizes…
Qualifications: Job Profile Summary: The Outreach Pharmacy Specialist is responsible for outbound calling to members, providers and pharmacies in an effort to improve HEDIS metrics. The Pharmacy Specialists will be…
Job Description: • Ensure independent oversight for Workday monitoring • Detail oriented • Monitor Workday Security activity • Monitor use of Change control tool to ensure compliance with process as designed • Monitor…
Title: Validation Engineer - II Location : 91750 La Verne, CA Duration: 6 Months Description: Responsible for performing validation of equipment, utility systems, facilities, processes and/or automation systems by…
Title: Operator, Warehouse 2 (SIAL) Location : Carlsbad, CA. 92008 Duration: 6 Months Purpose of The Position : A Warehouse Operator 2 is responsible for receipt, put away, transport and dispensing of GMP and non-GMP…
Duration: 12 Months + Contract SUMMARY OF POSITION: Required Competencies: • Experience in technical and clinical data review . • Attention to detail and problem-solving. • Excellent verbal, written and presentation…
Job Title : Customer Service Representative 1 Duration : 31 weeks (Temp to Hire) Location : Franklin TN 37067 Responsibilities : · Handles customer service inquiries and problems via telephone, internet or written…
Urgent Requirement of Registered Nurse /Case Manager with home care & children special needs experience in Columbus Ohio • A minimum of 1 year Home Health experience, or Case Management experience. Home Visits:…
Must meet all requirements for Principal Clinical Research Associate position and have demonstrated proficiency in all relevant areas. In partnership with CPMs, provides guidance and daily oversight for the successful…
Responsibilities: Under supervision from project managers, this position is responsible for scheduling and oversight of retrieval, review, and abstraction of medical record data performed by team members on their…
Summary Description: Accurately preps materials or assembles parts in trays and wraps trays to specification as outlined in job work order packet. Essential Duties And Responsibilities Accurately preps materials or…
Title : Administrative Support Duration : 3+ Months (Possible extension) Location : Philadelphia, PA Responsibilities : · Under the direction of the Manager, Clinical Outcomes & Therapeutic Optimization (COTO) the…
Job Title : Utilization Management Nurse Consultant Duration : 6 months (Possible ext) Location : Downers Grove, IL Responsibilities : · Facilitate the delivery of appropriate benefits and/or healthcare information…
Title: Registered Nurse HEDIS Location: Chattanooga, TN 37402 Duration: 7+ Months (Possible Extension) Responsibilities: The contract nurse is responsible for retrieval, review, and abstraction of medical record data,…
Responsible for the assessment, reassessment, care planning and coordination of care and services. Includes ongoing monitoring of an appropriate and effective person centered care plan, member education and care…
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