-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Davenport, US-IA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:39
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Wichita, US-KS
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:39
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Sioux City, US-IA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:38
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Springfield, US-IL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:37
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Des Moines, US-IA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:37
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Indianapolis, US-IN
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:36
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Fort Wayne, US-IN
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:35
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Evansville, US-IN
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:35
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Chicago, US-IL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:34
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Columbus, US-GA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:34
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Idaho Falls, US-ID
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:33
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Boise, US-ID
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:32
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Tallahassee, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:32
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Atlanta, US-GA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:29
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Savannah, US-GA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:26
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Jacksonville, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:25
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Dover, US-DE
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:24
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Tampa, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:24
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Miami, US-FL
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:23
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Hartford, US-CT
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:20
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Bridgeport, US-CT
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:19
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Wilmington, US-DE
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:19
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Colorado Springs, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:18
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: Denver, US-CO
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:17
-
Essential Duties and Responsibilities:
- Responsible for reviewing favorable, and partially favorable, determinations in accordance with applicable regulations.
- Render medical necessity determinations for Medicare State East cases assigned.
- Resolve all other technical issues within Medicare reconsideration assigned.
- Review cases to determine and summarize facts of each case assigned and assess issues involved in the case.
- May perform other special projects not related to a specific case such as general legal research, general medical research, drafting proposal sections, or acting as a liaison for a specific project, when necessary.
- Be the Subject Matter Expert (SME) for project.
- Perform other duties as assigned by management.
- Demonstrated skill in understanding diagnoses to assist clients in optimizing their level of function and self-care.
- Demonstrated knowledge of client education principles and the management of complex medical, psychosocial, and financial problems to enhance adherence to individualized treatment plans and train peers and staff.
- Knowledge and skills in the use of VA/DoW Clinical Practice Guidelines to support an evidence based, standardized process of care for military beneficiaries.
- Knowledge of the healthcare financial environment and the fiscal dimension of population health to ensure optimal stewardship of resources.
- Skill in the use of research tools to critically evaluate existing practices, opportunities, and outcomes.
- Knowledge of pharmaceuticals, including desired effects, side effects, and complications, to gauge their effect on clients and recovery.
- Knowledge of community resources, client entitlement and benefit eligibility, and the ability to access these resources to assist clients and families in optimizing function and self-care.
- Use of pre-established utilization and review criteria, and the ability to recognize and report actual or potential quality and risk management issues to improve practice and ensure compliance.
- Use of information systems and technology to manage individual or population health, continuously improve practice, and effectively communicate practice outcomes to stakeholders.
- Use of computers and software applications to conduct data collection, tracking, trending, and analysis, and to design and present computer-generated outcome analyses for educational programs or project briefings.
Minimum Requirements
- Bachelor's degree with 5-7 years of experience consulting within designated function.
- Advanced degree preferred.
- Develop solutions to highly complex problems which require a high degree of ingenuity and innovation.
- Ensure solutions are consistent with organization objectives.
- Solutions may serve as precedent for future decisions.
- Develop advanced concepts, techniques, and standards requiring a high level of interpersonal and technical skills.
- Develop new applications based on professional principles and theories.
- Viewed as exp...
....Read more...
Type: Permanent Location: San Francisco, US-CA
Salary / Rate: Not Specified
Posted: 2026-08-05 10:09:17
