- 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
- Veterans Affairs, Veterans Health Administration (Winter Park, FL)
- …satisfaction throughout the continuum of care. Responsibilities The Community Care (CC) Utilization Review Registered Nurse (RN) is responsible for collecting, ... clinical data for external reviewing and care coordination for the VAHCS. The CC Utilization Review RN performs a wide variety of clinical and technical tasks… more
- Veterans Affairs, Veterans Health Administration (Phoenix, AZ)
- …of the interdisciplinary team. Responsibilities Duties include but not limited to: Utilization Review (UR) Registered Nurse (RN) is responsible for providing ... care. The UR RN addresses psychosocial, as well as nursing and medical needs of patients and their families/caregivers, through participation in interdisciplinary… more
- Actalent (Sunrise, FL)
- …UMN assists in complex cases, develops internal processes, and educates physicians on utilization review issues. The role involves managing continuity of care, ... on department activities as assigned. Essential Skills + Clinical review + Utilization review +...program terms. If eligible, the benefits available for this temporary role may include the following: * Medical… more
- Actalent (Santa Barbara, CA)
- …Concurrent review , Prior authorization, Health care, Medicare, Managed care, Medical management, Case management, Utilization management, Claim Top Skills ... Details Data entry,Concurrent review ,Prior authorization,Health care,Medicare,Managed care, Medical management,Case management, Utilization management Additional Skills &… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... Overview AtCentinela Hospital Medical Center, our dedicated team of professionals are...Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure… more
- Actalent (Redlands, CA)
- …will review healthcare service requests to ensure they meet medical necessity and coverage requirements, assessing them against clinical guidelines and ... of Medicare, MediCal , and Milliman Criteria Guidelines. + Experience in utilization management and working with provider offices. + Proficiency in MCG criteria… more
- Veterans Affairs, Veterans Health Administration (Dublin, GA)
- …coordinated care delivery model. Coordinates with the patient care team to review clinic appointment availability ( utilization ) to ensure that clinic schedules ... Summary The Advanced Medical Support Assistant (MSA) serves at the Dublin...Announcement" for eligible applicants to be considered for these TEMPORARY POSTIONS NOT TO EXCEED 2 YEARS. The first… more
- Stony Brook University (Stony Brook, NY)
- …Department may include the following but are not limited to:** + Completes Utilization review screen for inpatient and observation cases. Activity includes UR ... Case Manager - Temporary **Position Summary** At Stony Brook Medicine, a...cases for authorization for in patient stay. + Staff review short stay, long stay and complex cases to… more
- The County of Los Angeles (Los Angeles, CA)
- ELECTION ASSISTANT III, NC ( TEMPORARY ) Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/1352861) Apply ELECTION ASSISTANT III, NC ( TEMPORARY ... ) Salary $38.38 Hourly Location Los Angeles County, CA Job Type Temporary Job Number E9315C Department REGISTRAR-RECORDER/COUNTY CLERK Opening Date 12/07/2023 +… more
- Unilever (San Francisco, CA)
- THE ROLE: SENIOR SUPPLY PLANNING ASSOCIATE The Temporary Senior Supply Planning Associate plays a crucial role in OLLY's Supply Chain by interpreting demand signals ... delivery of products. + Lead regular meetings with factories and co-packers to review production plans, capacities, and constraints. + Work with factory partners to… more
- CDPHP (Albany, NY)
- …of prescription and medical benefits as it applies to the utilization review process. + Must demonstrate proficient experience with the Microsoft ... Must be conscientious, efficient and accurate in prior authorization, exception and medical /Rx necessity review processing. + Continually strive to develop… more
- CDPHP (Albany, NY)
- …care pharmacy principles including prior authorization reviews, formulary management, and utilization review preferred. + Experience with Microsoft Office, ... Care Pharmacist -Level I is primarily responsible for the operational review of pharmacy medical exception/prior authorization requests, the communication… more
- Houston Methodist (Houston, TX)
- …on all new post-offer candidates, allied health professionals (not managed by medical staff credentialing), and other contract, agency, volunteers and students per ... physicians as appropriate. **QUALITY/SAFETY ESSENTIAL FUNCTIONS** + Conducts initial management, review and monitoring of all occupational injuries and illnesses. +… more
- Alight (TX)
- …If you did not already interview with our Alight Benefits Guidance team - please review other option positions on the Alight Careers Page Our story At Alight, we ... Benefit Advisor is responsible for enrolling client employees in their core medical and supplemental insurance benefits offered, performing the role as an expert… more
- Actalent (San Antonio, TX)
- …of cases. Essential Skills + Experience in utilization management, concurrent review , prior authorization, utilization review , case management, and ... decisions and gather additional information about the member's condition. Responsibilities: + Review approximately 20 cases a day for medical necessity. +… more
- Actalent (Fort Lauderdale, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... review the type of care being delivered, evaluate medical necessity, and contribute to discharge planning following established...program terms. If eligible, the benefits available for this temporary role may include the following: * Medical… more
- Actalent (Miami, FL)
- …complete cases. Qualifications: + 2+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... "Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical...program terms. If eligible, the benefits available for this temporary role may include the following: * Medical… more
- Actalent (Eagan, MN)
- …specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical , dental & vision * ... of your home? Join a dynamic team where your expertise powers critical utilization management decisions that directly affect patient care. This is more than just… more
- Actalent (Sunrise, FL)
- …Medical Directors and other Medical Management staff to direct utilization and capture data effectively. Responsibilities + Review prior authorization ... on department activities as assigned. Essential Skills + Clinical review + Utilization review +...program terms. If eligible, the benefits available for this temporary role may include the following: * Medical… more
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