- Trinity Health (Columbus, OH)
- …technology, financial analysis, audit, provider relations and more. **Position Purpose** RN Utilization Review MCHP is responsible for the coordination of the ... of the Sr. Director of Medical Management. + Coordinates with the utilization review , case management, discharge planning staff within network facilities.… more
- CenterWell (Topeka, KS)
- …member service or customer service telephone experience desired + Experience with Utilization Review and/or Prior Authorization, preferably within a managed care ... Administration Coordinator - Phone Intake contributes to administration of utilization management. The UM Administration Coordinator performs varied activities and… 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
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Utilization review ... tech essentially works to coordinate the utilization review and appeals process as part of the denial...an SME to support the UR tech team and remote counter parts with the specific processes as applicable.… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral health and substance use ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… 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
- R1 RCM (Boise, ID)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... **Location:** Remote , US **Shift:** Flexed weekday daytime schedule with...position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Dartmouth Health (White River Junction, VT)
- Utilization Review Case Manager – Home Health...to be discussed with hiring manager. Locations: * Fully remote work in all statesexcept: CA, CT, MA, MD, NJ, ... PRN, Days Why work as a Utilization Review Case Manager at Visiting Nurse and Hospice for Vermont and New Hampshire? * You experience satisfying and challenging… 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 ... competitive benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE **Position Purpose:** Performs a clinical review and assesses… more
- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** ** Remote - Pacific hours** ... strategies to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative… more
- Ascension Health (Cedar Park, TX)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... Management + **Schedule:** FT - Days + **Location:** Remote - **Must live within 60 miles of Texas...healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee… more
- Centene Corporation (New York, NY)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- AmeriHealth Caritas (Philadelphia, PA)
- …the case is presented to the Medical Director for medical necessity review . Upon approval of services, responsibilities include timely notification and education to ... patients in a clinical setting. + Minimum of 3 years of Utilization Management experience, preferably within a managed care organization. + Experience utilizing… more
- Centene Corporation (Jefferson City, MO)
- …competitive benefits including a fresh perspective on workplace flexibility. **_ Remote Role _** **Position Purpose:** Supervises Prior Authorization, Concurrent ... Review , and/or Retrospective Review Clinical ...ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources… more
- Ochsner Health (New Orleans, LA)
- …(2) Board Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (3) Physician Advisor Sub-Specialty ... Certification by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP) or (4) commitment to apply for such certifications +… more
- Centene Corporation (Austin, TX)
- …WILL HAVE BCBA CERTIFICATION **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members and ... utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Ochsner Health (Lafayette, LA)
- …+ Determines appropriate staffing levels and the interviewing, hiring, performance review , and termination of employees within practice unit(s); maintains employee ... in and will work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Illinois, Maryland, Minnesota, New York,… more
- UPMC (Pittsburgh, PA)
- …Changing Medicine happen. **Responsibilities:** + Actively participates in the daily utilization management and quality improvement review processes, including ... The Medical Director, Utilization Management is responsible for assuring physician commitment...health care to UPMC Health Plan members. This fully remote role will be responsible for assuring physician commitment… more