- The University of Vermont Health Network (Plattsburgh, NY)
- Unit Description: The Utilization Review Team monitors, collects and analyzes data and evaluates variances of resource utilization , complications and overall ... these skills assists the Medical Center in providing optimal care in a cost effective manner and promotes the...the efficient and effective use of patient services. The Utilization Review Team's role in data collection,… more
- Marion County (Salem, OR)
- …with entities on the state and local levels, and involves making sound clinical decisions with complex cases.Exceptional Needs Care Coordination Act as a ... staff regarding care recommendations, diversion opportunities, and Long-Term Psychiatric Care needs. With clinical supervisor acting as CMHP delegate,… more
- Saint Francis Health System (Tulsa, OK)
- …from an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care duties from an office location via ... Saint Francis Health System is seeking a Registered Nurse (RN) Virtual Care for a nursing job in Tulsa, Oklahoma.Job Description & RequirementsSpecialty: Virtual… more
- CHRISTUS Health (Alamogordo, NM)
- …status and assists him/her in ensuring proper placement of patient. Conducts utilization review using nationally recognized medical necessity criteria and ... Description Five years recent relevant clinical experience in an acute care ...there are actual or potential sources of under- or over- utilization . Collaborates with providers, nurses, patients, families, and other… more
- Marion County (Salem, OR)
- …making data-driven decisions that support our department mission. A commitment to excellent clinical quality to the population we serve and ability to maintain high ... reducing barriers and treating the whole person.LeadershipProvide leadership to the Clinical Supervisors, and Program Supervisor and teams in YFS. Leadership… more
- Medical Mutual of Ohio (OH)
- …nurse and support team members and operations of assigned commercial and government clinical care utilization management area. Evaluates team resources and ... in a supervisory or leadership capacity, or equivalent experience in utilization review , discharge planning, or a clinical practice. + Experience in assigned… more
- Elevance Health (Miami, FL)
- …RN license in the state of Florida. + Requires minimum of 5 years acute care clinical experience, utilization management or managed care experience; ... Senior RN Utilization Review /Management (Acute InPatient) JR116937 **Location:**...through the healthcare continuum and refers treatment plans/plan of care to clinical reviewers as required and… more
- Highmark Health (Camp Hill, PA)
- …**ESSENTIAL RESPONSIBILITIES** + Performs as the clinical subject matter expert for clinical , quality, care , utilization , high cost claim and population ... and accounts after customer discussions.Participate in ad-hoc and annual clinical review meetings as needed to provide...as quarterly and annual outcomes and trends for al clinical strategies for all current and emerging care… more
- Kepro (Los Angeles, CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a ... Utilization Clinical Reviewer , you'll harness...with experience navigating similar projects. + Ability to develop level-of- care recommendations based on clinical medical records… more
- Guthrie (Sayre, PA)
- …(UM) processes and requirements for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures ... Position Summary: The Utilization Management (UM) Reviewer , in collaboration...eligibility for licensure required Experience: Minimum of five years clinical experience in an acute health care … more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Position Overview: As a Utilization Reviewer , you involves reviewing medical records against appropriate criteria ... programs with experience navigating similar projects. + Ability to develop level-of- care recommendations based on clinical medical records and evaluations.… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer , MRx - Oncology - REMOTE **Job Description Summary** Key ... member of the utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Evolent Health (Columbus, OH)
- …mission. Stay for the culture. **What You'll Be Doing:** As a Vascular Surgery , Physician Clinical Reviewer you will be a key member of the utilization ... Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer , you will be a key member of the utilization ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Columbus, OH)
- …staff. Initial clinical reviewers are supported by Physician clinical review staff (MDs) in the utilization management determination process. + Reviews ... the culture. **What You'll Be Doing:** As an Initial Clinical Reviewer , you will be a key...**What You Will Be Doing:** + Functions in a clinical review capacity to evaluate all cases,… more
- Kepro (Richmond, VA)
- …Reviewer (part-time) to join our growing team. Job Summary: Our Behavioral Health Utilization Management Clinical Reviewer will use clinical expertise ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...assessment and critical thinking skills. + 1+ year of Utilization Review (UR) and/or Prior Authorization or… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...care managers and believe that coordinating high quality clinical and social services will result in better … more
- Centers Plan for Healthy Living (Margate, FL)
- RN - Grievance and Appeals Clinical Reviewer 5297 W Copans Rd, Margate, FL 33063, USA Req #461 Monday, June 3, 2024 Centers Plan for Healthy Living's goal is to ... plans they need for healthy living. JOB SUMMARY: The Grievance & Appeal Clinical Reviewer performs complex medical necessity reviewed on Initial Adverse… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- Position Purpose: The Clinical Reviewer will be responsible for conducting clinical reviews of medical records during the course of fraud investigations, ... eliminating fraud, waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System...+ 5 to 7 years of experience as a clinical reviewer and working with ICD-9/10 CM,… more
- Trinity Health (Livonia, MI)
- …time **Shift:** Rotating Shift **Description:** MBSC clinical nurse abstractor. The Clinical Nurse Reviewer 's chief responsibility is to collect and submit ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with...projects as may be identified. **PERFORMANCE DUTIES** **Documenting Patient Care ** + Responsible for the identification of patients for… more
