- Raytheon (Tucson, AZ)
- …initiatives.Coordinate program and department staffing needs, optimizing resource utilization , and supporting recruitment and retention efforts.Perform individual ... oversight to programs' product life cycle (design reviews, gate reviews, Material Review Board, Change Control Board, Process Change Board, and engineering peer… more
- Raytheon (Aurora, CO)
- …Management teams to streamline schedules, Monitor ICITE efficiencies, create and review related design documentation for the program.What You Will DoYou will ... Experience in managing and monitoring cloud environments, including resource utilization , performance, and securityCloud Security and Compliance, Problem-solving and… more
- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership and ... growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming,...Serve as the lead for CCA's Utilization Review functions working closely with other medical … 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 ... accuracy, compliance, and consistency. Job Responsibilities: + Conducting timely clinical review of Durable Medical Equipment (DME) requests in alignment… more
- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are...review , quality assurance, and medical review of complex, controversial, or experimental medical … more
- Elevance Health (Morgantown, WV)
- …work-life integration. **Work Hours** : Monday through Friday, 8am - 5pm The ** Medical Management Nurse** (Medicaid Utilization Review ) is responsible for ... whether treatment is medically necessary and provides consultation to Medical Director on cases that are unclear or do...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… more
- Commonwealth Care Alliance (Boston, MA)
- …in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required ... Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral...review behavioral health and substance use admissions for medical necessity and appropriate levels of care and assist… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Catholic Health Initiatives (Omaha, NE)
- …for our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! ... **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a...you will be responsible for conducting comprehensive reviews of medical records using evidence-based guidelines and critical thinking to… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team....+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Trinity Health (Columbus, OH)
- …of the Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities. + ... analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the...preferred. Demonstrated ability to analyze, summarize and concisely report medical utilization and medical chart… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... medical research to ensure the quality of the medical care provided to patients. Implements utilization ...center. Requires an MD, DO or DC. SUMMARY: The Medical Director performs medical review … more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **As a health care… more
- AmeriHealth Caritas (Washington, DC)
- …Systems to efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- ManpowerGroup (Columbia, SC)
- …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... medical reviews using established criteria and guidelines. + Review medical claims and determine reasonable charge...benefit guidelines. + Review interdepartmental requests for medical information to support utilization processes. +… more
- Banner Health (Phoenix, AZ)
- …delivery, focusing on value-based care, risk recapture, and quality outcomes. This role includes medical case review , utilization , and quality review , ... an environment of quality care and efficiency + Conduct medical case reviews, utilization and quality assessments,...and efficiency + Conduct medical case reviews, utilization and quality assessments, and make strategic recommendations for… more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... progress through written and verbal reports and through documentation in the medical record. Plan and schedule patient therapy based on individual needs. Schedules… more
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