ncqa jobs in Philadelphia

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

City/State Norfolk, VA Work Shift First (Days) Overview: Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse . The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and...

Work Shift Sentara Health Plans Community Care is looking to hire a Utilization Review Nurse . The Utilization Review Nurse is responsible for utilization management services within the scope of licensure. Conducts primary functions of prior authorization, retrospective review, medical director referrals and execution of member/provider approval and/or...

Healthcare Data AnalystThe Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reporting to help management from other departments do their jobs more effectively.The healthcare data analyst will...

Medical Director, Transplantation And Cellular TherapiesOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you...

For roles that are 100% remote or hybrid, you must have access to a reliable high-speed internet connection to support daily job responsibilities. A minimum bandwidth of 50 Mbps download and 5 Mbps upload is required. Those fully remote associates residing in states where service is required by contract, law, or regulation will be allowed to submit for...

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 safety and quality in everything we do. Join us and be part of something bigger...

Number of Positions In Requisition 1 Job Details The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reporting to help management from other departments do their jobs more...

Number of Positions In Requisition 1 Job Details The Healthcare Economics (HCE) team's primary function is to provide various clinical and financial analyses to management to support the business decision process. In addition, the team will provide consistent, accurate reporting to help management from other departments do their jobs more effectively. The...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...

Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.Reviews appeals for denied services related to current relevant medical experience or knowledge in accordance with appeal policies, if so delegated.Provides...