- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- Intermountain Health (Las Vegas, NV)
- **Job Description:** The Utilization Review Care Management Director is responsible for providing leadership and administrative direction for Utilization ... metrics. Leads the system-wide development of partnerships with payors to support Utilization Management. Collaborates with Castell, Home Care, Clinic Management… more
- HCA Healthcare (Nashville, TN)
- **Description** **Introduction** Do you have the career opportunities as a(an) Utilization Review Services RN you want with your current employer? We have an ... a committed, caring group of colleagues. Do you want to work as a(an) Utilization Review Services RN where your passion for creating positive patient… more
- HCA Healthcare (Nashville, TN)
- …Do you want to join an organization that invests in you as a Utilization Review Services Coordinator? At Parallonr, you come first. HCA Healthcare has ... and you have the opportunity to make a difference. We are looking for a dedicated Utilization Review Services Coordinator like you to be a part of our team.… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is...through more than 2,300 clinics, care sites and 137 hospital- based locations, in addition to its home -… more
- Children's Mercy Kansas City (Kansas City, MO)
- …and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family ... of, and training oversight of programs and services. Responsible for effective utilization review and proper resource management of patients, including patient… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... responsibility. The role requires daily participation in a structured authorization review queue and close adherence to workflow timelines and productivity… more
- AmeriHealth Caritas (Washington, DC)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Albany Medical Center (Albany, NY)
- …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Nuvance Health (Danbury, CT)
- …duties as required. Education: ASSOCIATE'S LVL DGRE Preferred : Two Years of Utilization Review experience Required : CT Registered Nurse License Working ... of care and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical necessity reviews… more
- Ascension Health (Wichita, KS)
- **Details** + **Department:** Utilization Review + **Schedule:** Full time, 36 hrs, Day shift, 7:30 AM- 4:00 PM, Monday-Friday, rotating weekends possible + ... care services regarding admissions, case management, discharge planning and utilization review . + Review admissions...home health services. Ascension is a leading non-profit, faith- based national health system made up of over 134,000… more
- Ascension Health (Jacksonville, FL)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Centene Corporation (Austin, TX)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... role have the flexibility to work remotely from their home anywhere in the Eastern or Central time zone,...previous behavioral health experience. **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Monte Nido (Miami, FL)
- …nutritional, and clinical strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible ... the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote -...facility based care and knowledge relating to utilization review methods, insurance authorizations **, Medicare**… more
- AmeriHealth Caritas (Philadelphia, PA)
- …requests for pediatric shift care services including skilled nursing and home health aide services, medical daycare, and pediatric residential facilities. Upon ... requested and may ask for additional supporting documentation when needed. Additionally, based on clinical judgement the Clinical Care Reviewer may contact the … more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … more
- Commonwealth Care Alliance (Boston, MA)
- …service authorization review for medical necessity and decision-making. The Nurse Utilization Management Reviewer has a key role in ensuring CCA meets CMS ... 013650 CCA-Auth & Utilization Mgmt **Position Summary:** Reporting to the Manager...**Essential Duties & Responsibilities:** + Conducts timely clinical decision review for services requiring prior authorization in a variety… more
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits...and auto loans *Eligibility for perks and benefits varies based on employee type and length of service. **Why… more
- Elevance Health (Buffalo, NY)
- …or case management experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or any combination of education ... residence required. **Preferred Skills, Capabilities and Experiences:** + A combination of utilization review / utilization management and Case Management (or… more
- BAYADA Home Health Care (Orlando, FL)
- …should be available Monday-Friday from 8:30am-5:00pm. _Medicare, Coder, OASIS Review , Utilization Review , Quality Assurance, Remote, Home Health Coding_ ... Review and Coding Manager. The OASIS and Coding Review Manager provides support to all BAYADA Home...+ This role is **fully remote,** candidates may be based anywhere in the US + Base Salary: $… more
Related Job Searches:
Based,
Home,
Home Based,
Review,
Review Home,
Utilization,
Utilization Review,
Utilization Review Home