- Kepro (CA)
- …you'll play a pivotal role in upholding industry benchmarks. This full-time Clinical Reviewer Remote position based in the state of California. This provides ... health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the California Mental Health… more
- Kepro (Minneapolis, MN)
- …partner for health solutions in the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. ... This is a Remote position Job Summary: The purpose of this position...of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with… more
- Kepro (Lombard, IL)
- …provide principal leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities ... in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join...stay criteria for IL Medicaid Fee-For-Service beneficiaries. *Position is remote but candidates must reside within the… more
- Magellan Health Services (Honolulu, HI)
- This is a remote /work from home position, candidates must ...Job Information Title HMSA Care Manager - BH, UM Reviewer - Remote Hawaii Grade 24 Work ... collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and substance abuse services provided in inpatient and/or… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... appropriate course of action for treatment. May analyze treatment patterns and utilization trends. Contributes to the development and implementation of action plans… more
- Centene Corporation (Tallahassee, FL)
- …competitive benefits including a fresh perspective on workplace flexibility. Candidate must reside in the state of Florida and hold required credentials/licensure ... with network practitioners to provide education on best practice models and utilization management processes + Interact with the Medical Director, or designee, to… more
- Insight Global (Philadelphia, PA)
- …to Case Management when indicated. Efficiently collaborates with the hospital utilization review department, attending physicians and members/families as ... insurance company local to the Philadelphia area is looking for to hire a fully remote Case Management RN to join their Care management team. Under the direction of… more
- Centene Corporation (Baton Rouge, LA)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... competitive benefits including a fresh perspective on workplace flexibility. **Location: Remote . Candidate must reside in Louisiana** **Hours: Schedule will… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Nurse** , you will help our hospital ... the evidence-based criteria. To thrive in this role, you must have experience in a clinical inpatient environment and...position. **Here's what you will experience working as a Utilization Review Nurse:** + Perform initial admission… more
- SSM Health (WI)
- …calling** WI- REMOTE **Worker Type:** Regular **Job Highlights:** + **Department:** Utilization Review + **Schedule:** Full Time, Day Shift, 8:30am-5:00pm; ... and** **equity for this role.** **)** + **Location:** Remote ( **candidate must live in IL,...all four states (IL, MO, WI, and OK)._ **Candidate** ** must ** **have prior hospital utilization review… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN STATE...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Elevance Health (Columbus, GA)
- …prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for the identification ... **Title: Utilization Management Representative I** **Location:** This position will...I** **Location:** This position will work a hybrid model ( remote and office). Ideal candidates will live within 50… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre\-certifications and appeals, ... judgement, and contractual eligibility\. + Occasional weekend work may be required\. + Must be able to pass Windows navigation test\. + Testing/Assessments will be… more
- AmeriHealth Caritas (Dublin, OH)
- …+ Assist in preparation, coordination, and participation in and follow up of Utilization Management audits, such as readiness review , Data Validation, CMS ... ** Utilization Management Plan Oversight Manager** Location: Dublin, OH...other administrative services. Discover more about us at www.amerihealthcaritas.com. ** Must be a resident of the State of Ohio.**… more
- AdventHealth (Altamonte Springs, FL)
- …. Develops and implements case management programs and education, including utilization review , transitions of care, disease management, population health ... **Senior Manager of Utilization ** **-AdventHealth Well65** **All the benefits and perks...(Travel** **across all Well 65 practices and will be remote when not at a practice)** **The role you'll… more
- CVS Health (Columbus, OH)
- …(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** -1+ years' experience Utilization Review experience -1+ years' experience Managed Care - ... and external constituents in the coordination and administration of the utilization /benefit management function. **Required Qualifications** - Must have active,… more
- CVS Health (Helena, MT)
- …UM ( utilization management) experience within an inpatient/outpatient setting, concurrent review or prior authorization. + 1+ years Managed Care (MCO) preferred. ... health care more personal, convenient and affordable. **Po** **sition Summary** **100% remote position from anywhere in the US** **Work hours: 11:30am-8:00pm EST,… more
- Elevance Health (Tampa, FL)
- Senior RN Utilization Review /Management (Acute InPatient) JR116937 **Location:** Must be within 50 miles / 1 hour commute of Tampa or Miami, FL offices. This ... is primarily a remote position but may be required to go in...preferred** . + 2 years of experience in In-Patient, utilization review / management, evaluating medical necessity… more
- Humana (Des Moines, IA)
- …and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to...independently under general instructions and with a team + Must be passionate about contributing to an organization focused… more
- CVS Health (Denver, CO)
- …* Knowledge of mental health and substance abuse disorders * Managed care/ utilization review experience * Crisis intervention skills * Position requires ... other internal and external constituents in the coordination and administration of the utilization /benefit management functions. Must be able to talk on the… more