Director of Utilization Review and Operations

Job Description:The Utilization Review Nurse's role is to ensure that health care services are administered with quality, cost efficiency, and within compliance. By continuously reviewing and auditing member treatment records, the utilization review nurse will ensure members do not receive unnecessary procedures, ineffective treatment, or experience...

Job SummaryWe are seeking a highly skilled and experienced professional to join our team as an Organizational Excellence Director. This role will play a critical part in driving excellence in nuclear safety and performance improvement across the industry.Key ResponsibilitiesLead site visit teams and peer review teams to identify gaps to excellence and...

Job SummaryWe are seeking a highly experienced and skilled National Director to lead our Managed Review operations. As a key member of our team, you will be responsible for developing and implementing our overall managed review sales and operations strategy.Key ResponsibilitiesDevelop and execute sales projections and budgets to drive business...

Job SummaryWe are seeking a highly experienced and skilled National Director to lead our Managed Review operations. As a key member of our team, you will be responsible for developing and implementing our overall managed review sales and operations strategy.Key ResponsibilitiesStrategic Planning: Set up sales projections and budgets to drive business...

Job SummaryKaiser Permanente is seeking a highly experienced and skilled Regional Utilization Management Director to provide leadership and direction for our regional utilization management program. This individual will be responsible for ensuring that our members receive high-quality healthcare in the most appropriate and cost-effective manner.Key...

Job SummaryAs a Regional Utilization Management Director at Kaiser Permanente, you will provide strategic leadership for joint Health Plan/TSPMG management efforts related to appropriate utilization of hospitals and specialty care. You will monitor transition of care, continuing care/sub-acute care resources, non-core hospital oversight to UM/case...

About the RoleAs a Utilization Review Nurse at Sidecar Health, you will play a critical role in evaluating the medical necessity and quality of healthcare services for our members. This involves reviewing medical records, ensuring compliance with established clinical guidelines and policies, and collaborating with healthcare providers to gather additional...

Job SummaryPiedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key ResponsibilitiesConduct detailed reviews of...

About the Role:Piedmont Healthcare Corporate is seeking a skilled Clinical Appeals Specialist to join our team. As a key member of our appeals process, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed...

Job Summary:Piedmont is seeking a highly skilled Clinical Appeals Specialist to join our team. As a Clinical Appeals Specialist, you will be responsible for reviewing and analyzing patient medical records to draft effective narratives for Medicare and Medicaid appeals documentation and briefs.Key Responsibilities:Conduct detailed reviews of patient medical...

Job SummaryWe are seeking a highly skilled and experienced professional to join our team as an Organizational Excellence Director. This role will play a critical part in driving excellence in nuclear safety and performance improvement across the industry.Key ResponsibilitiesLead site visit teams and peer review teams to identify gaps to excellence and...

At Hyatt, we believe our guests select Hyatt because of our caring and attentive associates who are focused on demonstrating Care in all aspects of their role. The Assistant Director of Operations - Food and Beverage is responsible for overseeing and directing Banquets, Restaurants, In-Room Dining, Lounges, Stewarding, and any other Food or Beverage related...

Job ID: #ExemptOldcastle Infrastructure, a CRH company, is the leading manufacturer of precast concrete, polymer concrete, and plastic products in the United States. Our products range from utility vaults, reinforced concrete pipe, catch basins, drainage and septic tanks, to retaining walls, storm shelters, wall panels, concrete barriers, a variety of...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required:8-10 years of comprehensive experience in the financial sector.Essential Skills:Proficient communication skills, particularly in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required8-10 years of comprehensive experience in the field.Essential SkillsProficient communication skills in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with transaction review...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required8-10 years of comprehensive experience in the field.Essential SkillsProficient communication skills in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with transaction review...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required:8-10 years of comprehensive experience in the field.Essential Skills:Proficient communication skills in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with transaction review...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required8-10 years of comprehensive experience in the field.Essential SkillsProficient communication skills in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with transaction review...

Position: AML Operations ManagerLocation: Atlanta, GA (100% Onsite)Experience Required8-10 years of comprehensive experience in the field.Essential SkillsProficient communication skills, particularly in written English.Background in Financial Services and Anti-Money Laundering (AML).Experience in managing teams effectively.Familiarity with transaction review...

Job SummaryWe are seeking a highly skilled Mechanical Systems Engineer to join our team at InsideHigherEd. The successful candidate will be responsible for providing engineering support and assistance to the Utilities Superintendent, Power Plant Superintendent, and Zone Manager in the operation, maintenance, and repair of mechanical utility generating and...