- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review - Remote . This position will work full- time in a 8-hr Day shift.** Provide prospective, retrospective, and ... Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... Science Nursing required OR four (4) years Case Management/ Appeal/ Utilization Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES… more
- CVS Health (Columbus, OH)
- …phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to ... As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ensuring members receive timely, medically… more
- Sedgwick (Cincinnati, OH)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance RN Utilization Review **Join us in a hybrid capacity, combining remote ... Blue Ash, OH office.** **PRIMARY PURPOSE** : To provide timely, evidence-based utilization review services to maximize quality care and cost-effective outcomes.… more
- Integra Partners (Troy, MI)
- …operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but are not… more
- Trinity Health (Columbus, OH)
- …of the Director, Utilization Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. ... of clinical nursing experience with at least 2 years' experience in utilization review or case management. Nursing experience in an HMO insurance setting… more
- Spectrum Billing Solutions (Skokie, IL)
- …in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but are not… more
- Trinity Health (Columbus, OH)
- …input of all inpatient admissions into database with proper ICD/ CPT coding for utilization review nurses. + Data entry of Health Risk Assessments into Access ... analysis, audit, provider relations and more. **Position Purpose** The Utilization Management Intake Coordinator provides administrative support to the medical… more
- Children's Mercy Kansas City (Kansas City, MO)
- …of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient ... reporting, quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome… more
- Centene Corporation (Harrisburg, PA)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... including a fresh perspective on workplace flexibility. **THIS POSITION IS REMOTE /WORK FROM HOME SUPPORTING PENNSYLVANIA HEALTH & WELLNESS MEDICAID CHIP PROGRAM.**… more
- Centene Corporation (Indianapolis, IN)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....service standards. *This position is on-site and NOT a remote position.* Requirements + Education: Clinical degree such as… more
- CommonSpirit Health (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records ... Coordination staff utilizing evidence-based guidelines and critical thinking. Additionally, as a Utilization Review RN, you will collaborate with the Concurrent… more
- Centene Corporation (New York, NY)
- …license; and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more
- AmeriHealth Caritas (LA)
- …Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...uses clinical judgment in their application **Work Arrangement** + Remote position + Monday through Friday 8:00 AM to… more
- Health Care Service Corporation (Albuquerque, NM)
- …decision making skills.** **PC and database experience.** **PREFERRED JOB REQUIREMENTS:** ** Utilization review experience.** **3 years clinical experience in ... position is responsible for ensuring accurate and timely clinical review of behavioral health cases (Applied Behavior Analysis (ABA))...be provided for this position._** **This is a Telecommute ( Remote ) role: Must reside within 250 miles of the… more
- Centene Corporation (Sacramento, CA)
- …perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review ... team to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence… more