- UNC Health (Chapel Hill, NC)
- …email, data base tasks, or other electronic communication and via telephone.Responsibilities:1. Clinical Review Process - Uses approved criteria and conducts ... unique communities we serve.RN Utilization Manager position specifically for a Utilization Manager/ Clinical Appeals Nurse. This person is based at the… more
- Marion County (Salem, OR)
- …An ideal candidate would be compassionate, highly collaborative, have strong clinical skills, and excellent written and verbal communication. We provide great ... with entities on the state and local levels, and involves making sound clinical decisions with complex cases.Exceptional Needs Care Coordination Act as a liaison… more
- Marion County (Salem, OR)
- …making data-driven decisions that support our department mission. A commitment to excellent clinical quality to the population we serve and ability to maintain high ... reducing barriers and treating the whole person.LeadershipProvide leadership to the Clinical Supervisors, and Program Supervisor and teams in YFS. Leadership… 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...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental… more
- Guthrie (Binghamton, NY)
- …for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate * Documents ... LPN - Utilization Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external… more
- Cleveland Clinic (Stuart, FL)
- …three to five years of experience working in a hospital. * Has utilization review experience. * Demonstrates strong critical thinking and problem-solving skills. ... but also a home away from home. As a Utilization Management (UM) RN Reviewer , you will...UM activities which include admission review , concurrent review , retrospective chart review and 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 ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… more
- Kepro (Richmond, VA)
- …partner for health solutions in the public sector. Acentra seeks a Behavioral Health UM Clinical Reviewer ( part -time) to join our growing team. Job Summary: ... Our Behavioral Health Utilization Management Clinical Reviewer will use clinical expertise to review medical records against appropriate criteria in… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer , MRx - Oncology - REMOTE **Job Description Summary** Key ... member of the utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Evolent Health (Columbus, OH)
- …the mission. Stay for the culture. **What You'll Be Doing:** As a Vascular Surgery, Physician Clinical Reviewer you will be a key member of the utilization ... Provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- Evolent Health (Columbus, OH)
- …Evolent for the mission. Stay for the culture. **What You'll Be Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization ... provides clinical rationale for standard and expedited appeals. + Utilizes medical/ clinical review guidelines and parameters to assure consistency in the MD… more
- DOCTORS HEALTHCARE PLANS, INC. (Coral Gables, FL)
- …and experience in the analysis and processing of claims, utilization review , quality assurance procedures, payment methodologies and Part D - Pharmacy ... Position Purpose: The Clinical Reviewer will be responsible for...eliminating fraud, waste and abuse. Responsibilities: + Perform the clinical review in Standard Claims Processing System… more
- Banner Health (AZ)
- …on your experience as a Registered Nurse and your knowledge of Case Managment and Utilization Management to review clinical records to ensure patients are in ... or other staff of non-company locations on concurrent and retrospective utilization review . Accurately and thoroughly completes documentation required for… more
- Beth Israel Lahey Health (Burlington, MA)
- …in utilization review and medical necessity activities Key responsibilities: Utilization review and inpatient clinical optimization: (include all ... **Job Type:** Regular **Time Type:** Part time **Work Shift:** Day (United States of...payor provider representatives, participation in the observation escalation process, clinical reviews of utilization review … more
- Beth Israel Lahey Health (Burlington, MA)
- …Medical Center is now offering up to a $3,500 in signing bonuses for our Utilization Review positions. Important Details: * Signing Bonuses are paid out in three ... Description:** **Job Description:** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate… more
- Riverside Community Care (Norwood, MA)
- …policies and external regulations. . Provide training, guidance, and support to clinical staff on utilization review processes, documentation requirements, ... health services provided to our clients by conducting comprehensive Utilization Reviews as part of a multi-disciplinary...the ability to review and interpret complex clinical documentation and utilization data accurately. .… more
- Beth Israel Lahey Health (Needham, MA)
- …difference in people's lives.** In conjunction with the admitting/attending physician, the Utilization Review RN assists in determining the appropriate admission ... billed. Conducts concurrent reviews as directed in the hospital's Utilization Review Plan and review ...Registered Nurse (RN), Massachusetts + Three years of recent clinical or utilization management experience _Preferred:_ +… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... medical specialty and subspecialty. In addition to its direct clinical services, DHS also runs the Emergency Medical Services...and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General… more
- Beth Israel Lahey Health (Burlington, MA)
- …0 **Work Shift:** Day (United States of America) Joint role of Case Manager and Utilization Review Nurse Hospital at Home Per Diem, potential for weekends, days, ... Case Manager for Hospital at Home Care Transitions coordinates utilization review , discharge planning and monitors quality...status patients by working with physicians to ensure appropriate utilization . 9) Is part of the department's… more
- Prime Healthcare (Ontario, CA)
- …Administration, or another relevant field + A minimum of seven (7) years' experience in Clinical Utilization Review or Case Management with a large Health ... Applicants: https://www.primehealthcare.com/wp-content/uploads/2024/04/Notice-at-Collection-and-Privacy-Policy-for-California-Job-Applicants.pdf Responsibilities The Corporate Director of Clinical Utilization Management (UM) provides… more
