- Detroit Medical Center (Detroit, MI)
- Detroit Medical Center is seeking a Registered Nurse (RN) Utilization Review for a nursing job in Detroit, Michigan.Job Description & RequirementsSpecialty: ... for case management scope of services including: Utilization Management services supporting medical necessity and...based on Medical Necessity and submits case for Secondary Physician review per Tenet policy Ensures timely… more
- Intermountain Health (Columbus, OH)
- **Job Description:** Physician will provide Physician Advisor Utilization Reviewer and Central Appeals Work services. Physician shall engage, ... Physician shall work in partnership with the utilization review committee to ensure procedures are...physician to be on-call as the second IPAS reviewer for those cases where Physician is… more
- Intermountain Health (Las Vegas, NV)
- …position interacts with UM physician and operational leadership. As the UM Physician Reviewer , you are responsible, in partnership with the Sr. Director of ... Leadership. Job Profile: + Trains and educates on medical review activities pertaining to utilization review...criteria, and state, local, or federal guidelines relating to utilization management . + Demonstrated knowledge of case… more
- CommonSpirit Health (Houston, TX)
- …Candidates licensed in other states will be considered for future openings.** As the Utilization Management Physician Advisor II, the Physician Advisor ... staff ensuring that the system is optimized for effective physician use. The PA helps facilitate training for the...Steering Committee + Extended Length of Stay Rounds + Utilization Review Committee + Care Management… more
- Beth Israel Lahey Health (Burlington, MA)
- …resource allocation - Serves as physician expert and provide support to utilization review team regarding utilization decisions pertaining to commercial ... necessity recommendations, as requested Policy Setting Responsibilities Responsible for utilization review and medical necessity recommendations, as requested… more
- Guthrie (Sayre, PA)
- Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external offices, payors, and providers and staff, is ... responsible for the coordinates Utilization Management (UM) processes and requirements for...prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate… more
- Cleveland Clinic (Stuart, FL)
- …not only an excellent medical facility, but also a home away from home. As a Utilization Management (UM) RN Reviewer , you will work under the general ... years of experience working in a hospital. * Has utilization review experience. * Demonstrates strong critical...a minimum of 85% on IRR quarterly. + Completes Utilization Management for assigned patients with a… more
- Kepro (Charleston, WV)
- … reviewerr statewide in West Virginia for an exciting opportunity. As an RN Utilization Management Reviewer , you will be actively involved in ... + Determines approval or initiates a referral to the physician consultant and processes physician consultant decisions...Virginia. + Minimum of 2 year of experience in Utilization Review (UR), Prior Authorization, or related… 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 your expertise...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental… more
- Prime Therapeutics (Columbus, OH)
- …- Oncology - REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests that do ... needed or required. **Job Description** + Directs daily involvement in the following utilization management functions: + Reviews all cases in which clinical… 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 ... ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA).… more
- Intermountain Health (Murray, UT)
- …4. Oversees the management physician reviewer services, including management of scheduling, optimizing review process, and quality reviews. 5. Peer ... physician peer review and clinical direction for SelectHealth including utilization management , case management , appeals, criteria and policy… more
- Atlantic Health System (Hackettstown, NJ)
- …process, CMS required patient notices and other regulatory requirements within the utilization management process. 10. Maintains proficiency in the application ... for CMS required patient notices. 8. Completes and documents utilization reviews, physician advisor referrals and other...of organization selected clinical review criteria sets evidenced through IRR testing Graduate of… more
- Evolent Health (Columbus, OH)
- …Surgery, Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Evolent Health (Columbus, OH)
- …As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference in ... management staff, other Physicians, and staff whenever a physician `s input is needed or required. **What You Will... and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National… more
- Kepro (Lombard, IL)
- …vital partner for health solutions in the public sector. Acentra seeks a Psychiatrist Physician Reviewer (Illinois Remote, PRN) to join our growing team. Job ... Summary: The Psychiatrist Physician Reviewer will provide principal leadership and...and clinical expertise to operations relating to the peer review process, utilization review activities,… more
- Apex Health Solutions (Houston, TX)
- …a contact and resource person to Health Solutions' members for the utilization review (UR) of healthcare services. The UM Reviewer will be responsible for ... or UR questions or issues arise. To support care management initiatives, the UM Reviewer should also...Licensed Vocational Nurse required and current unrestricted Certification in Utilization Review / Utilization Management … more
- Elevance Health (San Juan, PR)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... from one of the 50 states of the United States. + Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including… more
- Kepro (AL)
- …the physical therapist will perform prior authorization reviews for the Alabama Utilization Management contract. The Physical Therapist will utilize clinical ... verbal and written communication skills required. Preferred Experience + Previous utilization management experience preferred but not required. + Knowledge… more
- Medical Mutual of Ohio (OH)
- …consistent and quality health care services. + Keeps up to date on utilization management regulations, policies and practices. + If assigned to Preceptor/Trainer ... 3 years as a Registered Nurse with a combination of clinical and or utilization /case management experience, preferably in the health insurance industry. + Acute… more
