utilization review coordinator

Regular Exempt **GENERAL DESCRIPTION:** Evaluates utilization in clinical records and hospital facilities concurrently and retrospectively. Identifies and refers to other clinical departments (Case management, condition management, among others) cases for the management of treatment alternatives. Makes efforts to receive advice in difficult...

**Purpose Statement** Proactively monitor utilization of services for patients to optimize reimbursement for the facility. **Essential Functions** - Act as liaison between managed care organizations and the facility professional clinical staff. - Conduct reviews, in accordance with certification requirements, of insurance plans or other managed care...

Eaton’s ES AMER PCS division is currently seeking a SCM Project Lead.  ## What you’ll do: **PRIMARY FUNCTION:** Lead SCM project activities for Power Components Division Sites. Ensure activities are completed based on the required timeline while managing CAPEX, cost out and other goals. Work with other department process owners to complete...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for handling, validating, and completing requests and reconciliations related to the Beneficiary Value Program. Assess program reconciliation and collaboration with cross-functional teams to enhance overall program performance to ensure that the Beneficiary Value Program goals align with the...

Regular Exempt **GENERAL DESCRIPTION:** The Events and Promotions Executive is responsible for handling and coordinating the logistics of Classicare events and activities and the efforts and initiatives related to the Advantage line of business. Identifies and develops work plans for region-level initiatives and provides recommendations to...

**Description** The Assistant Department Manager is responsible for the managerial direction and leadership of interns, designers and assistant-level engineers within the Substation Department of the T&D Global Practice in the Puerto Rico office. This position involves leadership and technical execution with direct involvement in projects. Specific...

## Overview PURPOSE STATEMENT: Manage the client's/patient's/resident’s cases with a solid background of clinical knowledge and expertise and may be responsible for providing some therapeutic services to clients/patients/residents. ## Responsibilities ESSENTIAL FUNCTIONS: · Provide case management and care coordination services for...

**Purpose Statement** Manage the client's/patient's/resident’s cases with a solid background of clinical knowledge and expertise and may be responsible for providing some therapeutic services to clients/patients/residents. **Essential Functions** - Provide case management and care coordination services for clients/patients/residents in the...

Regular Non-Exempt **GENERAL DESCRIPTION:** Analyzes claims and/or adjustments submitted in Centers for Medicare and Medicaid Services Form 1500 (CMS‑1500) and Uniform Billing Form 04 (UB‑04) formats, as well as member reimbursements, by applying payment rules to determine appropriate adjudication, denial, or the need for additional...

Descripción del Puesto y Formulario de Requisitos de Adiestramiento del Puesto (Job Description and Role Training Requirements Form) Propiedad de Consumer Healthcare (CH) – No puede ser utilizada, divulgada o publicada sin el consentimiento de CH. Sólo las versiones controladas son válidas. Documento firmado electrónicamente (Veeva) y...

Imperial Brady is a leading North American distributor and solutions provider for cleaning and facility care, foodservice, and packaging. With more than 13,000 employees and a broad supply chain network, we deliver national scale with local expertise. Built on strong customer relationships and deep industry knowledge, we go beyond distribution—delivering...

**Who We Are:** SPECTRAFORCE is at the forefront of redefining the staffing, technology, and consulting sectors. Privately and diversity-owned, we're among the fastest-growing firms in the US, on a short-range mission to hit the $1B revenue mark. Our success is rooted in the principle of human connection, epitomized by our NEWJOBPHORIA ethos - the joy and...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for identifying, analyzing, and implementing impactful health services network management initiatives focused on enhancing service quality, driving process improvements, and ensuring contractual compliance. Translates strategic plans into actionable initiatives, effectively operationalizing them...

The OpportunityTetra Tech is seeking a Safety Officer in Puerto Rico who will be responsible for developing, monitoring, and implementing health and safety policies to ensure that program(s) follow health and safety laws and regulations and to reduce or prevent hazards, dangers, and accidents. Why Tetra TechAt Tetra Tech, we are Leading with...

Hourly pay range for this position is $30.98–$46.33 (based on experience). In addition, the position offers medical, dental, and vision insurance, as well as a 401(k) plan. Summary The Digital Marketing Coordinator, working in collaboration with and in support of the firm’s strategic initiatives, is a key contributor within the Digital...

We Are The People Who Give Possibilities PurposeBD is one of the largest global medical technology companies in the world. Advancing the world of health™ is our Purpose, and it’s no small feat. It takes the imagination and passion of all of us—from design and engineering to the manufacturing and marketing of our billions of MedTech products per...

About OncoHealthOncoHealth is a leading digital health company dedicated to helping health plans, employers, providers, and patients navigate the physical, mental, and financial complexities of cancer through technology enabled services. Supporting more than 14 million people in the US and Puerto Rico, OncoHealth offers digital solutions for treatment...

Job Summary: Under the supervision of the Assistant Plant Controller, the Program Coordinator – Training & Grants supports the execution and day-to-day management of a WIOA-funded training initiative at TPR. This role plays a key part in ensuring that all activities related to the grant are carried out in alignment with federal requirements and...

Service Project Supervisor Manage controls, mechanical, and electrical projects consisting in major repairs, design and build, or new installations. Leads the service team to produce services required to keep buildings in shape and under budget, exceeding customer expectations consistently. Job Description & Responsibilities Plan, manage...

Optum 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 will find a culture guided by inclusion, talented...