- Guardian Life (Bethlehem, PA)
- As the **Clinical Specialist II, LPN/ LVN ** you will be a licensed Practical or Vocational Nurse who is knowledgeable in a variety of medical and behavioral ... You may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to facilitate… more
- STG International (Milledgeville, GA)
- STGi is seeking a LPN/ LVN to provide services at our Georgia War Veterans Home. GWVH will be opening a new unit that will be dedicated to the needs related to ... could be the job for you! JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + Ensure the… more
- STG International (Temple, TX)
- …not on the formulary 4. Comply with all VA reporting per VLB timelines 5. Review RX policy and procedures annually 6. Represent community with agencies as needed 7. ... care in pharmacy ordering, alternative substitutions and off formulary utilization . 25. Participates as a team member in the...Corps - 60J, 60L, 61F, 61H, 61N, 61R,62B Medical Specialist Corps - 65B, 65C, 65D Nurse Corps -… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... insurance, Worker's Compensation and Medicare guidelines pertaining toProspective and Retrospective Utilization Review . Some experience in medical deviceor DME… more
- Cedars-Sinai (Los Angeles, CA)
- …Experience: A minimum of 5 years of experience in Acute Clinical Care, Utilization Review , Coding, or Case Management required Working knowledge of Joint ... has named us one of America's Best Hospitals. As our next Clinical Documentation Specialist , you will work under the general direction of the HID CDI/Core Measures… more
- Guardian Life (Bethlehem, PA)
- As the **Clinical Specialist LPN/RN, Disability Claims** you will perform necessary outreaches to claimants or treating providers to obtain certification dates, ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed in order to… more
- Molina Healthcare (Midvale, UT)
- …Managed Care Experience in the specific programs supported by the plan such as Utilization Review , Medical Claims Review , Long Term Service and Support, ... Medical Officer on denial decisions. + Resolves escalated complaints regarding Utilization Management and Long-Term Services & Supports issues. + Identifies and… more