, and utilizing knowledge of medical necessity criteria for all levels of behavioral health care from outpatient office visits... accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the...
At Luminare Health , our employees are the cornerstone of our business and the foundation to our success. We empower... retention, ongoing quality, turnaround time and service expectations. This manager is responsible for staff development...
Required Such As Special Investigations, Customer Service, Pass, Network Management, Marketing, Case Management, Medical Review, Legal, Pricing... auditing or developing computer system reports. Knowledge of accreditation, i.e. URAC, NCQA standards and health insurance...
management (cm) and is a primary source of contact for members, health care personnel and all other entities involved in managing... in Care Management in a health insurance/managed care setting Current CCM certification Knowledge of medical...
. Required Job Qualifications: Bachelor Degree and 3 years experience in health plan, regulatory compliance or risk management OR 6 years... experience in health plan, regulatory compliance or risk management Ability to communicate with and build relationships...
service necessities for all of our business purposes and employees of our corporation. · Directs and manages effective... within, as well as outside the corporation. · Extracts and monitors the best service possible from service vendors. · Coordinates activities...
, IL Headquartered in the heart of downtown Chicago, HCSC is the largest private, member-owned health insurer in the United States..., or PhD. Experience in the healthcare industry, especially the health insurance sector. Experience with corporate strategy...
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a pur...
At HCSC, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers. Join HCSC and be part of a pur...
for leading, coordinating and participating in Credentialing Delegation oversight audits of HCSC’s vendors, service providers... Degree in Business or Medical OR 3 or more years’ experience in a managed care environment. 2 years in a leadership role...