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Manager- Quality & Acc.
WNS Global Services
Leads the Quality Management Program, including annual program evaluation, quality improvement initiatives, KPI development, performance monitoring, and implementation of continuous process…
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Clinical Services Manager- DMC-ODS
California Mental Health Services Authority
The Clinical Services Manager provides clinical leadership and serves as the designated Compliance Officer for CalMHSA’s multi-county Drug Medi-Cal Organized Delivery System (DMC-ODS)…
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Utilization Management RN
WPS Health Solutions New
Can work cross functionally to support other departmental efforts to ensure overall efficiency, quality, productivity, and compliance with all departmental, regulatory and URAC standards.
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Manager, Utilization Management
Centene Management Company LLC
Manages prior authorization, concurrent review, appeals, and/or retrospective clinical review team and ensures compliance with applicable guidelines, policies, and procedures
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Senior Clinical/Operations Internal Monitoring Manager
Clover Health
The Senior Manager of Internal Monitoring plays a pivotal role in leading and overseeing second-level auditor monitoring across all ODAG functions - including Utilization Management (UM),…
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Registered Nurse (RN) Clinical Compliance Auditor- Remote
Guidehealth
The Clinical Compliance Auditor II is responsible for ensuring Guidehealth’s clinical operations, utilization management activities, and delegated services comply with regulatory…
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Registered Nurse (RN) Clinical Compliance Auditor- Remote
Guidehealth
The Clinical Compliance Auditor II is responsible for ensuring Guidehealth’s clinical operations, utilization management activities, and delegated services comply with regulatory…
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Nurse - Clinical Review
WNS Global Services
Keeps current with guideline, policy, and regulatory updates from the Compliance Department and Nursing Management, and adheres to URAC, NCQA, HIPAA, and state and federal requirements.
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Nurse Team Lead - Clin Rev
WNS Global Services
Knows the requirements of each assigned benefit management program, including regulatory compliance, accreditation standards, and client service levels by line of business and geographic…
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Clinical Quality Pharmacist
MedImpact Healthcare Systems Inc.
Responsible for quality assurance of PA and Appeals notifications meeting compliance with accreditation, regulatory, and client requirements
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Accreditation Quality & URL Specialist II
MedImpact Healthcare Systems Inc.
Serves as accreditation subject-matter expert for NCQA and/or URAC standards and for all or specific program sections, to consult and update internal partners on accreditation efforts and…
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Director Utilization Management
Mountain Region Support
…peak efficiency. You will play a vital role in maintaining regulatory compliance and accreditation standards, managing complex payer requirements, and mitigating denials through proactive…
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Behavioral Health Utilization Manager (Outpatient and Non-24 Hour Diversionary Services) CBHI
WellSense Health Plan
The Behavioral Health Utilization Manager plays a critical role in ensuring the appropriate and effective delivery of mental health and substance use disorder services. This role serves as…
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RN Utilization Management Reviewer
Sagility LLC
Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
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RN Utilization Management Reviewer
Sagility LLC
Works with UM Manager and other clinical leadership to ensure that departmental and organizational policies and procedures as well as regulatory and contractual requirements are met
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Systems Architect 2, MLOps Engineer
UM Corp (Enterprise)
Functions as an independent project lead or provides oversight for project manager and/or business analyst on assigned projects and recognize/ minimize business value lost during…
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Sr. Sponsored Programs Specialist
UM Corp (Enterprise)
Accesses applicable database(s) to verify regulatory compliance approvals before establishing of the project account.
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Utilization Management Registered Nurse (RN) - Remote
Guidehealth
Ensure ongoing compliance with federal and state regulatory requirements across multiple jurisdictions and medical groups.
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RN Case Manager - Behavioral Health (Remote)
Guidehealth
…collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members…
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RN Case Manager - Behavioral Health (Remote)
Guidehealth
…collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members…
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RN Case Manager - Behavioral Health (Remote)
Guidehealth
…collaborative health partner in their health care team. As an RN Case Manager, the RN will work closely with client and members alike to promote wellness, problem-solve, and assist members…
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Utilization Management Registered Nurse (RN) - Remote
Guidehealth
Ensure ongoing compliance with federal and state regulatory requirements across multiple jurisdictions and medical groups.
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Utilization Management Registered Nurse (RN) - Remote
Guidehealth
Ensure ongoing compliance with federal and state regulatory requirements across multiple jurisdictions and medical groups.
Added
Utilization Management Registered Nurse (RN) - Remote
Guidehealth
Ensure ongoing compliance with federal and state regulatory requirements across multiple jurisdictions and medical groups.
Added
Clinical Compliance Auditor - Remote
Guidehealth
The Clinical Compliance Auditor II is responsible for ensuring Guidehealth’s clinical operations, utilization management activities, and delegated services comply with regulatory…
