- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- Centene Corporation (Springfield, IL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... time zone with experience in mental health settings and utilization management / review . * Department: PHCO...+ LCSW- License Clinical Social Worker required or + LMHC- Licensed Mental Health Counselor required or + LPC- Licensed… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been ... within an intimate home setting. We are seeking a Utilization Review Clinician to join our team...providing direct care to individuals with an eating disorder preferred. + Licensed behavioral health clinician/provider, RD, or RN… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions to improve...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you… more
- UnityPoint Health (Cedar Rapids, IA)
- …S + Shift: 40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key ... coordinating the department's interdisciplinary effort to assess and promote appropriate utilization of health care resources, provision of high-quality health care,… more
- Children's Mercy Kansas City (Kansas City, MO)
- …within 4 years of hire + 1-2 years experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...Missouri required upon hire + One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas… more
- State of Indiana (Evansville, IN)
- Utilization Review Coordinator-LPN Date Posted: Aug...practice nursing in the State of Indiana as a Licensed Practical Nurse. + Must hold and maintain a ... Services certification as a Psychiatric Medicare/Medicaid Hospital. Role Overview: The Utilization Review Coordinator performs duties within a psychiatric… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more
- Dartmouth Health (Lebanon, NH)
- Overview Utilization Review Per Diem - Remote Works with physicians and multidisciplinary team members to develop a plan of care for assigned patients. Ensures ... leadership, communication and computer skills desired. Required Licensure/Certifications - Licensed Registered nurse with NH eligibility * Remote:Fully Remote *… more
- Avera (Cresco, IA)
- …to join us on our mission, apply today! **Position Highlights** POSITION SUMMARY: The Utilization Review Coordinator is a member of the nursing team and ... QUALIFICATIONS: Registered Nurse from an accredited school of nursing is required. BSN preferred. Licensed for a minimum of one year as a Registered Nurse in the… more
- Centene Corporation (Phoenix, AZ)
- …Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. ... within utilization management. + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more
- UNC Health Care (Smithfield, NC)
- …episode through post discharge for quality, efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ... are met and care delivery is coordinated across the continuum. The Utilization Manager completes admission, continued stay, and discharge reviews in accordance with… more
- Helio Health Inc. (Syracuse, NY)
- …preferred. + Licensed /credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care setting. ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Integra Partners (Troy, MI)
- …in a payer or managed care environment. + Strong understanding of utilization review , authorizations, and appeals processes. + Excellent verbal/written ... The Utilization Management (UM) Nurse Supervisor is responsible for...necessity criteria (eg, InterQual, CMS, health plan policies). + Review and process clinical and administrative appeals; coordinate with… more
- Humana (Richmond, VA)
- …problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change, ... of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills… more
- Wellpath (Lemoyne, PA)
- …The Medical Director of Utilization Management leads and oversees utilization review , case management, quality improvement, and related policy and ... lives saved by Narcan. We offer ongoing training and development opportunities for licensed and unlicensed healthcare team members, and have best in class clinical… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Humana (Olympia, WA)
- …Coordinator or discharge planner in an acute care setting + Previous experience in utilization management/ utilization review for a health plan or acute care ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
- Humana (Indianapolis, IN)
- …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... put health first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge… more
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