- Novo Nordisk Inc. (Plainsboro, NJ)
- About the Department The Clinical, Medical and Regulatory (CMR) department at Novo Nordisk is one of the most diverse and collaborative groups within the ... and developing and implementing regulatory strategies with the FDA to providing medical education and collecting data to support efficacy and new product… more
- Eisai, Inc (Nutley, NJ)
- …for internal medical training content. Train new hires on EMAC organization/ utilization .Provide input into and collaborate with regional and global medical ... At Eisai, satisfying unmet medical needs and increasing the benefits healthcare provides...MSL managers. Develop congress abstract tracker, assign MSL coverage, review MSL reporting responsibilities, collate and distribute Congress Report,… more
- Novo Nordisk Inc. (Olathe, KS)
- …proactive collaboration with internal teams such as Sales, Marketing, Market Access, Medical , Legal, and Compliance, contributing to NNI's CM Sales organization and ... and adapting to business priorities Educate HCPs to increase product utilization , optimize treatment, and align with evidence-based medicine and guidelines, while… more
- Novo Nordisk Inc. (Plainsboro, NJ)
- …(Pricing, Contracting, Operations and Reimbursement), HEOR, Marketing, Commercial Sales, Medical Affairs, and Legal & Compliance. External relationships include ... their placement in the treatment continuum as well as appropriate utilization and treatment guidelines Proactively leverages detailed knowledge of all applicable… more
- Novo Nordisk Inc. (Boston, MA)
- …and Professional Associations. Internally, this position will collaborate with STARS Medical Liaisons, and STARS Account Managers. Essential Functions Attention to ... collateral development Achieve or exceed assigned sales objectives through effective utilization of all available resources, strategies and tactics Collaborates with… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- State of Connecticut, Department of Administrative Services (New Haven, CT)
- Utilization Review Nurse (40 Hour) Office/On-Site Recruitment # 250715-5612FP-001 Location New Haven, CT Date Opened 7/22/2025 12:00:00 AM Salary $78,480 - ... care delivery and reimbursement systems; + Participates in utilization review and/or quality assurance programs; +...third-party administrator files to oversee contractor handling; + May review medical records of various health care… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. Applies the appropriate clinical criteria/guideline and… more
- Commonwealth Care Alliance (Boston, MA)
- …Knowledge, Skills & Abilities (must have): * Expertise in managing utilization review processes including prior authorization, concurrent and retrospective ... is responsible for overseeing and managing the daily operation of the Utilization Management Review Nurse and Specialist staff responsible for conducting… more
- Ascension Health (Baltimore, MD)
- **Details** + up to $5,062 gross full weekly travel rate + **Department:** Ascension Travel Program & Interim Leadership + **Schedule:** Full-time + ... Please consult with your Recruiter to learn more. Will serve as an Interim Travel Nursing leader with the potential to serve various Ascension hospitals. For more… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a ... to the Utilization Management Manager. * Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas,… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...**Knowledge, Skills and Abilities (KSAs)** + Proficient in standard medical practices and insurance benefit structures. + Proficient in… more
- CVS Health (Phoenix, AZ)
- …the right care at the right time. You'll use evidence-based guidelines and medical necessity criteria to guide utilization and benefit decisions, helping young ... each and every day. **Location:** Remote (Arizona residents only) ** Travel :** Occasional travel up to 10% to...Care is the place for you. **Key Responsibilities** + Review clinical information and apply medical necessity… more
- Guidehouse (New York, NY)
- …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse ** Travel Required** **:** None **Clearance Required** **:** None...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
- Ventura County (Ventura, CA)
- …+ Experience with managed care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review systems and programs + At ... care + Experience and current knowledge of Quality Assurance, Utilization Review and Peer Review ...Review systems and programs + Direct patient care medical practice experience + Administrative experience + National Committee… more
- Molina Healthcare (Bellevue, WA)
- …license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel within applicable state or ... candidate with a WA state LPN licensure. Candidates with case management, Utilization Management (UM), and direct managed care experience are highly preferred.… more
- Molina Healthcare (San Jose, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 DAY SHIFT 7:30AM - 08:30PM...requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and… more
- Molina Healthcare (Nampa, ID)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
