34 Utilization Management Jobs - Page 2

The RMO Manager is responsible for designing, building, and managing the end-to-end talent demand and supply management process to ensure timely talent fulfillment, maximize revenue realization, and drive operational efficiency. This role entails close collaboration with Commercial, Delivery, HR & Talent Acquisition, and Finance teams to align workforce strategies with business objectives. The key aspects of this role include data-driven decision-making, demand forecasting, capacity planning, bench management, utilization improvement, process standardization, and team leadership to enhance operational excellence across the organization. Responsibilities Talent Demand & Supply Management: - D...

As a Registered Nurse (RN) with active, unrestricted license in [state], your primary responsibility will be to review and assess clinical information submitted with Prior Authorization (PA) requests to determine medical necessity, appropriateness, and benefit coverage. You will conduct clinical evaluations for outpatient, inpatient, and specialty services, including J-code medications and durable medical equipment (DME) as applicable. It will be essential for you to apply CMS Medicare Advantage guidelines, internal policies, and clinical criteria (such as MCG/InterQual) to make informed decisions. Collaboration will be a key aspect of your role as you work closely with physicians, pharmacis...

Role & responsibilities Come join our team! Help us tackle the data usability challenge for payers. Your expertise and experience will help drive meaningful performance outcomes. You'll also have the chance to advance your career, acquire new skills, and collaborate with some of the most innovative minds in payer data management. We are seeking an experienced Business Analyst with Utilization Management and Care Management subject matter expertise to join our growing team. You will act as a liaison between business stakeholders, the data modeling team, and technical teams, ensuring client needs and business requirements are translated into actionable technical specifications resulting in sea...

Profile Overview:We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles ru...

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles r...

Responsibilities: * Loading of FLYASH from silo or dykash * Unloading of flyash in mines or highways* Trip or fleet management * Daily trip management of vehicles* Responsible to handle smooth operations of ash discharge* Responsible to handle smooth fleet operations, loading and unloading of ash in vehicles.* Proper planning of manpower as and when required.* Loading of ash from the silo to Hywa, dumpers and assigning bills.* Handle contractors and vendors for smooth ash disposal from the sites. * Operate the ash unloading equipment and drive the ash-hauling trucks to dispose of the coal ash. Desired Profile:* Any graduate with 1 to 8 yrs of experience in FLY ash management.* Excellent rela...

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles r...

Profile Overview: We are looking for an experienced professional in the FLYASH Thermal sector, who will oversee and manage business operations at the assigned Thermal power plant by setting up the entire operations team for flyash disposal. Job Description Responsible for setting up the entire operations team. Assisting and overseeing the site engaged in disposing ash from Thermal power for both fly and legacy ash disposal as per the margins agreed by the management. Monitor the work progress on a regular basis and formulate reports as required (daily, weekly monthly, yearly planning etc) Arranging local transporters from power plants to mines/low-lying areas and ensuring that the vehicles r...

Role & responsibilities We are seeking a dedicated Utilization Management Specialist to join our Chennai office. In this role, you will be responsible for reviewing and analyzing clinical information to determine the medical necessity and appropriateness of healthcare services, ensuring compliance with established guidelines and policies. Your expertise will contribute to optimizing patient care and resource utilization. Key Responsibilities Conduct prior authorization, concurrent, and retrospective reviews for various healthcare services, including inpatient, outpatient, home health, and behavioral health. Apply evidence-based criteria (e.g., MCG, InterQual) to assess the necessity of medic...