- The Oncology Institute of Hope and Innovation (Cerritos, CA)
- …75+ clinic locations and growing. TOI is changing oncology for the better. Utilization Management Medical Director Oncology Work Location: REMOTE (work from ... of utilization management protocols and criteria specific to oncology. Review and assess the appropriateness of ongoing cancer treatment plans, ensuring that… more
- Trinity Health (Silver Spring, MD)
- …Full time Shift: Day Shift Description: Job Title: RN Case Manager - Utilization Management Employment Type: Full Time Shift: Day Location : Holy Cross Hospital ... Position Purpose: As a Case Manager in Utilization Management, you will be the key to ensuring...care and address clinical documentation needs for accurate case review and status determination. Oversee the continuity of care… more
- Actalent (St. Paul, MN)
- Clinical Review Pharmacist (100% Remote ) Job Description In this role, you will utilize your clinical skills to conduct utilization management reviews, ... contracts evaluated every six months for extension. Responsibilities Conduct utilization management reviews, including prior authorizations, coverage exceptions, and… more
- Guidehealth (Joliet, IL)
- …experienced in Case Management and Chronic Condition Management. Knowledge of utilization review , quality improvement, managed care, and/or community health. ... and provider outreach, data collection and analyzation, reporting, clinical review , medical and behavioral health assessments, and documentation in...Previous remote and/or telephonic work experience. Basic knowledge of case… more
- ThinkBAC Consulting (West Palm Beach, FL)
- Job Description Renewables Asset Manager, Commercial Strategy - Energy Storage Locations: FULLY REMOTE (Anywhere in the USA) This an opportunity to join an industry ... renewable energy portfolio. It will also help pioneer the build-out and utilization of a proprietary battery storage / energy storage management platform for… more
- UnitedHealth Group (Los Angeles, CA)
- …will provide expertise and leadership on population, specifically Clinical Documentation Review with expertise in application of DRG coding and clinical operations. ... high-quality DRG-based clinical reviews within the Optum Enterprise Innovative DRG Clinical Review program and be an excellent written and spoken communicator (eg,… more
- Gallagher (Rolling Meadows, IL)
- …There may be an opportunity to convert to Full-Time employee. - This is a fully remote position. We will provide the equipment as long as you have your own high ... on available resources and tools to support decision-making for and effective utilization of benefit plan options. Stay informed about company policies and processes… more
- NexTec Group (Dallas, TX)
- …must be located in the United States or Canada. This is a remote role. Objectives (Key Outcomes): Complete assigned tasks independently and may collaborate with ... skill sets and within alignment of the Statement of Work, Business Process Review (BPR) documentation, and NexTec methodology. Maintain at least 75 percent … more
- Molina Healthcare (Long Beach, CA)
- …or Licensed Practical Nurse (LPN) Program Required Experience Minimum two years Utilization Review experience. Knowledge of audit processes and applicable state ... and federal regulations. Required License, Certification, Association Active, unrestricted State Licensed Vocational Nurse or Licensed Practical Nurse in good standing. Preferred Education Completion of an accredited Registered Nurse (RN) Program or a… more
- Actalent (St. Paul, MN)
- Clinical Review Pharmacist - 100% Remote $55/hr | Full-Time | Contract-to-Hire | Make a Real Impact from Anywhere Why This Role Rocks Join a team of pharmacy ... this fully remote role, you'll use your clinical expertise to review and approve (or deny) requests like prior authorizations, formulary exceptions, and quantity… more
- NFP (Charlotte, NC)
- …ideally working hybrid from our Charlotte, NC office. We will consider a remote option for well-experienced Commercial Lines candidates able to work on an EST ... of insurance, and other related items accurately and on time Monitor and review client satisfaction Electronically document all communication with clients Review … more
- American Recruiting and Consulting Group (Jacksonville, FL)
- …and payment rules * Work experience in the health insurance industry, a utilization review firm, or another health care claims processing organization in ... MEDICAL DIRECTOR - REMOTE ARC Group has an immediate opportunity for...* Provide clinical consultation to internal teams (eg, medical review staff, appeals teams) and external stakeholders. * Provide… more
- Actalent (Boston, MA)
- …complying with all company policies and standards. Essential Skills Proficiency in clinical review , case management, utilization review , and utilization ... Clinical Review Clinician Job Description As a Clinical ...NCQA, Medicare, and Medicaid regulations is preferred. Familiarity with utilization management processes is preferred. State Licensure as LPN,… more
- UnitedHealth Group (Wausau, WI)
- …medical records, benefit plans, medical policies, and other various criteria Utilization Management, pre-authorization, concurrent review , or appeals experience ... you will be putting your detective skills to the test as you investigate and review a variety of medical services. If you are looking for a challenging and rewarding… more
- UnitedHealth Group (Minneapolis, MN)
- …work with groups of nurses and support staff to manage inpatient care utilization at a hospital, market, regional or national level. You'll enjoy the flexibility ... of evidence-based medicine (EBM) such as InterQual care guidelines and criteria review Occasionally, may participate in periodic market oversight meetings with the… more
- AFL (Duncan, SC)
- …- including Lead Generation, Pricing Manufacturing and Metrics (ie machine utilization , scrap, yields, downtime, material, overhead rates, BOMs, Kanban & kitting) ... working closely with executives, general managers, operations, and commercial teams. Review results against plans/forecasts to ensure variations and key drivers are… more
- UPMC Senior Communities (Pittsburgh, PA)
- …in accordance with current budget. Oversee scheduling of patients to ensure proper utilization of time and patient beds. Maintain, order, and clean all monitoring ... and communicate with physicians and mid-level providers. Oversee and review the work of the EEG or EMG technical...meet departmental and hospital requirements Assist in the annual review of the EEG or EMG technical staff. Assist… more
- DaVita, Inc. (Owensboro, KY)
- …assisting them in navigating a challenging healthcare system. Through medical record review and consultation, you will identify the medical, social, emotional, and ... support the Owensboro, KY area. Must live locally. Position Details: Location: Hybrid- Remote . Work from home (telehealth) and travel within an assigned geography for… more
- NorthShore (Warrenville, IL)
- …(American Red Cross) is preferred. Experience: Minimum three (3) years of utilization review , discharge planning, case management or disease management ... Monday - Friday (8:30 am -5:00 pm), 2 days onsite required and 3 days remote optional. Weekend and holiday required per rotation. Remote optional for weekend and… more
- VA Northeast Ohio Healthcare System (Kent, OH)
- …Duties: Schedules patient appointments Coordinates with the patient care team to review the clinic utilization by using various reports; Maintains effective ... set by the hiring official. Telework : Not available Remote : This is not a remote position....delivery model. Coordinates with the patient care team to review clinic appointment availability utilization ) to ensure… more
