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Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.
Primary Purpose
Reviews requests for prior authorization and appeals for approval or denial of claims payment based on medical necessity. Oversees medical coordination required for effective utilization and quality management of the health plan network. Supports the clinical activities of PCHP Utilization Management, Quality Management, Clinical Policy, Technology Assessment, Credentialing, Population Health and Fraud, Waste and Abuse Functions to assure comprehensive, high quality health care to plan members in accordance with managed care and PCHP policies. Monitors clinical care needed to produce optimal health outcomes and cost-effective care.
Minimum Specifications
Education
Experience
Equivalent Education and/or Experience
Certification/Registration/Licensure
Required Tests for Placement
Skills or Special Abilities
Responsibilities
Job Accountabilities
Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.
About the Company:
Parkland
Full Time
Professional Associations
$220k-277k (estimate)
03/06/2024
06/02/2024
parkland.com
CLEVELAND, OH
100 - 200
Private
P KELLY TOMPKINS
$10M - $50M
Professional Associations