- Henry Ford Health System (Troy, MI)
- …system-wide improvements and operational processes to ensure optimal and compliant utilization review strategies. Under minimal supervision from the Manager ... GENERAL SUMMARY: The Supervisor of Utilization Management has an important role in a high-profile group tasked with implementing… 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 and ... And we do it all with heart, each and every day. This position will be remote working from home anywhere in the US. **Schedule is Monday - Friday 8am-5pm est.** No… more
- Centene Corporation (Jefferson City, MO)
- …members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various related functions ... complex and often conflicting requirements. + Oversee the operations of utilization management, reconciliation coordination, concurrent review (telephonic and… more
- CVS Health (Phoenix, AZ)
- …compassionate. And we do it all with heart, each and every day. **Location:** Remote (Arizona residents only) **Travel:** Occasional travel up to 10% to Phoenix, AZ ... of children and adolescents? Join Mercy Care as a Behavioral Health Utilization Management Clinician and become part of a mission-driven team that's transforming… more
- Centene Corporation (San Antonio, TX)
- …substance abuse is preferred. + Knowledge of mental health and substance abuse utilization review process is preferred. + Experience working with providers and ... to mental health and substance abuse is preferred. + Utilization Review / Utilization management with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Catholic Health Initiatives (Omaha, NE)
- …2 hours of a Commonspirit Health Facility Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient ... patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Monte Nido (Miami, FL)
- …save lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** ** Remote - EST or CST ... provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting...billing and account follow-up. This is a Full Time remote position supporting our virtual programs on East and… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Current driver's license required… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- CVS Health (Charleston, WV)
- …all with heart, each and every day. **Position Summary** This is a **fully remote position** open to applicants residing in the **Eastern Standard Time Zone** . ... , **evidence-based clinical criteria** , and **clinical practice guidelines** to review and authorize services requiring precertification. Most of the work is… more
- BJC HealthCare (St. Louis, MO)
- …nurse experience performing care for hospitalized patients. + 2 years of utilization review (UR) experience reviewing hospital admissions for medical necessity ... team. This is a great opportunity for a local remote position. **Schedule** PRN (As needed) + Shifts will...medical services provided by the medical team. Ensure appropriate utilization , which includes the evaluation of potential under and… more
- Children's Hospital Boston (Boston, MA)
- …Title:Per Diem RN Case Manager, Utilization Management/ReviewDepartment:Patient Services-Patient Care OperationsAutoReqId:80451BRStatus:Part-TimeStandard Hours per ... Posting Description:Department Summary: The UM Case Managers at Boston Children's review documentation within 1 business day of patient admission to assess… more
- Adecco US, Inc. (Minneapolis, MN)
- …under the direct supervision of an RN or MD. . Performs utilization review activities, including pre-certification, concurrent, and retrospective reviews ... Nurses** ! This role is work from home and remote but we are requiring Nurses to live in...turn around times. . Reviews, documents, and communicates all utilization review activities and outcomes including, but… more
- Ochsner Health (Lafayette, LA)
- …+ Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee ... in and will work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Illinois, Maryland, Minnesota, New Jersey, New… more
- CVS Health (Baton Rouge, LA)
- …of varied UM ( utilization management) experience within an inpatient, concurrent review or prior authorization. + Remote work experience. **Education** + ... with heart, each and every day. **Position Summary** **100% remote position from anywhere in the US** **Work hours:...utilization management) experience within an **outpatient** setting, concurrent review or prior authorization. + 5 years of a… more