- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are...review , quality assurance, and medical review of complex, controversial, or experimental medical … more
- Novant Health (Winston Salem, NC)
- …compliance. The UR clinician coordinates and conducts initial, concurrent, and retrospective medical necessity reviews. All Utilization Review activities are ... Job Summary The Utilization Review Clinician serves as a leader resource in the Utilization Review process for Behavioral Health acute care . They… more
- Vanderbilt University Medical Center (Lebanon, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for ... **Discover Vanderbilt University Medical Center** : Located in Nashville, Tennessee, and...* Clinical Applications Systems (Novice): Possesses fundamental proficiency in utilization review systems, clinical support systems and… more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Prime Healthcare (Joliet, IL)
- …licensure. #LI-MP2 Connect With Us! (https://careers-primehealthcare.icims.com/jobs/203251/ medical - review -coordinator-i utilization ... Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief ...both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Catholic Health Initiatives (Omaha, NE)
- …for our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! ... healthcare delivery system. **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... medical research to ensure the quality of the medical care provided to patients. Implements utilization ...center. Requires an MD, DO or DC. SUMMARY: The Medical Director performs medical review … more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **As a health care… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed ... (CHC) -- Cigna. **Summary description of position** : A Medical Principal performs medical review ...will serve as a clinical educator and consultant to utilization management, case management, network, contracting, pharmacy, and service… more
- AmeriHealth Caritas (Dover, DE)
- …Systems to efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- ManpowerGroup (Columbia, SC)
- …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... medical reviews using established criteria and guidelines. + Review medical claims and determine reasonable charge...benefit guidelines. + Review interdepartmental requests for medical information to support utilization processes. +… more
- Elevance Health (Indianapolis, IN)
- …MA, Chicago IL, or Atlanta GA, Woodland Hills, CA. **Summary** The Behavioral Health Chief Medical Officer oversees Utilization Review , Peer Review and ... the Executive Leadership and Senior Leadership Teams in the areas of medical provider relations, quality management, utilization management, clinical systems… more
- LifePoint Health (Las Cruces, NM)
- …**Organization:** **Memorial Medical Center* **Title:** *Registered Nurse (RN) - Utilization Review - Full Time* **Location:** *New Mexico-Las Cruces* ... *Your experience matters* At Memorial Medical Center, we are driven by a profound...on qualifications and experience * Shift differentials * Comprehensive medical , dental, and vision plans, plus flexible-spending and health-… more
- Insight Global (Long Beach, CA)
- …role within the healthcare industry - Care Review , Care Coordinator, Medical Assistant, Patient Services, Utilization Review , Authorization, Eligibility, ... Job Description Insight Global is seeking Care Review Processors to join the Utilization Management team to help with the influx of membership growth. To be… more
- Banner Health (Phoenix, AZ)
- …delivery, focusing on value-based care, risk recapture, and quality outcomes. This role includes medical case review , utilization , and quality review , ... an environment of quality care and efficiency + Conduct medical case reviews, utilization and quality assessments,...and efficiency + Conduct medical case reviews, utilization and quality assessments, and make strategic recommendations for… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
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