- NORTH EAST MEDICAL SERVICES (Burlingame, CA)
- …Salary Range $128752.00 - $165048.00 Salary Description SUMMARY OF POSITION: The Utilization Management (UM) Nurse is a licensed nursing professional responsible for ... the inpatient UM process, including initial and concurrent case reviews, review of inpatient skilled nursing and rehabilitation treatment requests, and facilitate… more
- Moriah Behavioral Health (Kingston, PA)
- …by utilizing online websites or by contacting carriers directly. Communicates with Utilization Review /Admissions Teams for Verification of Benefits (VOB), change ... and updated information to ensure accuracy of billing. Works seamlessly with Utilization Review , Clinical, and Admission Teams to develop best practices,… more
- UHS (Corona, CA)
- …www.swhealthcaresystem.com . Job Summary: Southwest Healthcare is seeking a Full-Time Remote RN Clinical Documentation Integrity Specialist . Duties include but ... retrospective review of inpatient medical records to evaluate the utilization and documentation of acute care services.Responsible for improving the overall… more
- GLOBALHEALTH HOLDINGS LLC (Oklahoma City, OK)
- Job Details Job Location GlobalHealth OKC - Oklahoma City, OK Remote Type Fully Remote Position Type Full Time Job Shift Day Description WHO WE ARE: GlobalHealth ... Case Manager Complete TOC activities to include post-discharge assessment, medication reconciliation/ review , and ensuring member has access to follow up care.… more
- Ipsen (Los Angeles, CA)
- Title: Clinical Science Specialist , Pediatric Liver, Southwest Company: Ipsen Biopharmaceuticals Inc. About Ipsen: Ipsen is a mid-sized global biopharmaceutical ... Liver Disease. In this field-based role as a Rare Disease Clinical Science Specialist - Cholestatic Liver (Pediatrics) , you will be accountable for: Achieving or… more
- Talent Connect Now (San Diego, CA)
- …and Nurse Practitioners. The Medical Director also interfaces and collaborates with specialist physicians in the provider network. Note : All employees responsible ... of participant care (resources), clinical outcomes, performance improvement, and Utilization Management (UM). Designs and conducts quality projects and stays… more
- UC Davis Health (Sacramento, CA)
- …Access Experience ensuring compliance of specialty pharmacy accrediting bodies [e.g., Utilization Review Accreditation Commission (URAC), The Joint Commission ... The Pharmacy Technician Specialist is responsible for gathering information from medical...prescription adjudication rejections with insurance companies Experience in chart review and working with health insurance companies. Experience with… more
- Veterans Health Administration (Dayton, OH)
- …and current staff. Incumbent serves as a member of the Medical Center Blood Utilization Review Committee. As a committee member, the incumbent is responsible for ... Summary The incumbent serves as a Technical Specialist Clinical Laboratory Scientist (CLS) for Blood Bank...Opens in a new windowLearn more about federal benefits. Review our benefits Eligibility for benefits depends on the… 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
- 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 ... patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! As our … more
- St. Luke's University Health Network (Allentown, PA)
- …of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical necessity and tracks ... outpatient denials for experimental, coding or other issues that may require record review . Provides billing with information needed to obtain payment of claims. … more
- University of Miami (Hialeah, FL)
- …Documentation Specialist 1 provides clinically based concurrent and retrospective review of inpatient medical records to evaluate the documentation and ... or staff position using the Career worklet, please review this tip sheet (https://my.it.miami.edu/wda/erpsec/tipsheets/ER\_eRecruiting\_ApplyforaJob.pdf) . The Clinical...utilization of acute care services. + Facilitates appropriate physician… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... our Operations Training & Development team as an Operations UM Training Specialist , specializing in Utilization Management (UM) processes. The ideal candidate… more
- Army National Guard Units (Colchester, VT)
- …EXCEPTED SERVICE POSITION. This National Guard position is for an IT Specialist (NETWORK),Position Description Number T5239000 and is part of the Information ... Responsibilities The incumbent functions as the technical coordinator or technical specialist on issues relating to the WAN/LAN systems and their integration… more
- Pfizer (Lansing, MI)
- …patients. **What You Will Achieve** The Rare Cardiac, Amyloidosis Multi-disciplinary Specialist (AMS), will target health care providers (HCPs), spanning multiple ... will report into the Area Business Manager (ABM). Amyloidosis Multi-disciplinary Specialist (AMS) will demonstrate strong business acumen and an expert understanding… more
- Washington County Hospital and Clinics (Washington, IA)
- …leadership to monitor effectiveness of training efforts. Monitoring may include routine review of reports and utilization data used in the development ... Informatics Specialist Job Details Job Location Washington Co Hospital - Washington, IA Remote Type Hybrid Position Type Full Time Job Shift Day Job Category… more
- Robert Half Accountemps (Laguna Hills, CA)
- Description A Healthcare Laboratory company is in the need of a remote Medical Billing Collections Specialist . The Medical Billing Collections Specialist ... (HMO, PPO, IPA, TPA Indemnity) and Patient Billing. The Medical Billing Collections Specialist must possess detailed knowledge of all medical benefit levels and a… more
- AdventHealth (Daytona Beach, FL)
- …will be remote . **The role you'll contribute:** The Oncology Data Specialist Certified is responsible for improving quality and outcomes for the Cancer Institute ... public reporting. The ODS-C serves as the Cancer Registry content expert to review patient diagnosis, treatment, and outcomes across the care continuum. The ODS-C is… more
- Huntington National Bank (Pittsburgh, PA)
- Description Summary: The Insurance Program Senior Compliance HR Specialist position is responsible for delivering the Employee Benefits Compliance suite of services ... for clients. + Plan Document preparation services (in-house), including carrier certificate review to determine discrepancies in plan provisions as well as plan… more
- State of Arkansas (Rogers, AR)
- PARK SPECIALIST II Date: Jul 18, 2025 Req ID: 50189 Location: Rogers, AR, US, 72756 Category: DEPT OF PARKS AND TOURISM Anticipated Starting Salary: $14.00 per hour ... Trail Maintenance Coordinator advertised as Park Specialist II [Part Time] Position #: 22091990 Salary: $14.00 per hour Grade: GS03 Requisition: 50189 Location:… more
