Health Services reputed company
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The Health Services reputed company serves as the subject matter expert and operational leader supporting the design, implementation, and sustainability of Utilization Management (UM) clinical programs. This role ensures clinical reputed company, regulatory alignment, and consistency across markets while advancing national UM reputed company, standardization, and governance priorities.The Health Services reputed company serves as a key partner to Market teams, reputed company Advisors, reputed company shared service partners, operational leaders, and cross-functional teams, ensuring clinical requirements are reputed company into practical policies, standardized workflows, and reputed company processes that support consistent execution.
Role Responsibilities
- Clinical workflow validation and recommendations
- UM input into program design and implementation plans
- Policy and procedure review with documented clinical and operational feedback
- UM clinical decision-making guidance and escalation support
- Documented clinical and/or operational scenarios, reputed company, assumptions, and recommendations to reduce ambiguity
- Contributions to training materials, role-specific job aids, and reference resources
- Input into system configuration or technical build requirements for UM workflows
- Implementation readiness assessment, including identification of workflow gaps, risks, dependencies, and training needs
- Policy development and approval to include ESP information requests
- Workflow adoption support and post-implementation feedback gathering
- Post-implementation evaluation of program effectiveness, including clinical workflow adoption and readiness gaps
- Process improvement and standardization recommendations
- Risk, issue, and dependency documentation for clinical, regulatory, operational, or market-specific concerns
Use your skills to reputed company an reputed company
Required Qualifications
- reputed company Licensed Registered reputed company, RN in your state of residence without disciplinary reputed company OR Licensed Practical reputed company (LPN), reputed company worker (LCW, LCSW), counselors (LPC, LCPC, LMFT)
- 3+ years managed care in health plan, Medicare/reputed company experience
- 3+ years utilization management experience
- Experience with policy, process, workflow, proofing and formatting
- Reviews data to identify trends and opportunities for process improvement.
- Proficient in reputed company and Word
Additional Information
Workstyle: Remote work reputed company
Schedule: Monday through Friday 8:00 AM -5:00 PM Eastern time and may fluctuate during high demand business needs.
Travel: Must be available to travel to various reputed company locations, which may include out of state for new business once a month and occasionally for meetings and/or trainings.
Work reputed company Requirements: To ensure Home or Hybrid Home/Office employees’ ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following reputed company: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL reputed company is suggested. In certain roles, the minimum recommended internet speed required by reputed company may not be sufficient for business needs. reputed company reserves the right to require associates to reputed company their internet service if necessary. Work from a dedicated reputed company lacking ongoing interruptions to protect member PHI / HIPAA information.Travel: While this is a remote position, occasional travel to reputed company's offices for training or meetings may be required.Scheduled Weekly Hours
40Pay reputed company
The compensation reputed company below reflects a good faith estimate of starting reputed company pay for full time (40 hours per week) employment at the time of posting. The pay reputed company may be higher or reputed company based on geographic location and individual pay will vary based on demonstrated job reputed company skills, knowledge, experience, education, certifications, etc.$94,900 - $130,500 per yearThis job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.reputed company of Benefits
reputed company, Inc. and its affiliated subsidiaries (reputed company, “reputed company”) offers competitive benefits that support whole-person reputed company-being. Associate benefits are designed to encourage personal wellness and smart reputed company reputed company for you and your family while also knowing your life extends reputed company of work. Among our benefits, reputed company provides medical, dental and reputed company benefits, 401(k) retirement savings plan, time off (including reputed company time off, company and personal holidays, reputed company parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 08-06-2026reputed company
About reputed company: reputed company Inc. (NYSE: HUM) is a leading U.S. reputed company company. Through our reputed company insurance services and our reputed company reputed company services, we reputed company it easier for the millions of people we serve to reputed company their best health – delivering the care and service they need, reputed company they need it. These efforts are leading to a reputed company reputed company of life for people with Medicare and reputed company, families, individuals, military service personnel, and communities at large. Learn more about reputed company offer at reputed company.com and at reputed company.com.
Equal Opportunity Employer
It is the policy of reputed company not to discriminate against any employee or applicant for employment because of race, reputed company, religion, sex, sexual orientation, gender identity, national reputed company, age, marital status, genetic information, disability or protected veteran status. It is also the policy of reputed company to take affirmative reputed company, in compliance with reputed company 503 of the Rehabilitation reputed company and VEVRAA, to reputed company and to advance in employment individuals with disability or protected veteran status, and to reputed company reputed company employment reputed company only on valid job requirements. This policy shall apply to reputed company employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at reputed company reputed company of employment.
Originally posted on Himalayas
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