- AmeriHealth Caritas (Dover, DE)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Evolent (Dover, DE)
- …As a Clinical Reviewer, Nurse , you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... Clinical reviewers are supported by Field Medical Directors (MDs) in the utilization management determination process. + Reviews charts and analyzes clinical… more
- CVS Health (Dover, DE)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... using a keyboard **Preferred Qualifications** - 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care - 1+ years' experience in Utilization Review - CCM and/or other URAC… more
- CVS Health (Dover, DE)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... in **Oncology** **.** **Preferred Qualifications** + 1+ years' Case Management experience or discharge planning, nurse navigator...lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC… more
- CVS Health (Dover, DE)
- …current unrestricted state licensure required in state of residence **Preferred Qualifications** Utilization Management review Managed Care experience Client ... each and every day. **Position Summary** Responsible for the review and evaluation of clinical information and documentation. Reviews...processing experience **Education** Registered Nurse **Anticipated Weekly Hours** 40 **Time Type** Full time… more
- Lincoln Financial (Dover, DE)
- …Care, Orthopedics, Coronary Care, , Trauma , Disability, Workman's comp or case management or Utilization review **Application Deadline** **What's it like ... Role at a Glance** We are excited to bring on a highly motivated Nurse Disability Consultant to our clinical organization. This position will be responsible for… more
- Highmark Health (Dover, DE)
- …triaging members to appropriate resources for additional support. + Implement care management review processes that are consistent with established industry, ... Nursing **EXPERIENCE** **Required** + 7 years in any combination of clinical, case/ utilization management and/or disease/condition management experience, or… more
- Fresenius Medical Center (Dover, DE)
- …and acts as the liaison for patient care as per the disease management agreement, including initial and ongoing validation of member eligibility. Facilitate timely ... workup of patients for access management , dialysis services, patient education, hospitalizations, and kidney transplantation as appropriate, and ensures coordination… more
- Highmark Health (Dover, DE)
- …timeframes and notification requirements are met + Communicate effectively with Utilization Management Staff, providers, other internal and external customers ... regulatory requirements. Document, process and route requests for services to the nurse reviewer and other departments based on documentation procedures, including … more
- BAYADA Home Health Care (New Castle, DE)
- …Manager** in our **New Castle, DE** office. We are also open to a **Registered Nurse (RN)** interested in this position! As Rehab Manager you will lead the field ... and procedures. Rehab Managers are also accountable for internal case management , field staff evaluation and development. The successful Physical Therapist,… more
- Evolent (Dover, DE)
- …years of direct clinical patient care + **Minimum one year of experience with Utilization Review (UM) in a managed care environment** + **Cardiology and Oncology ... identifies and refers quality issues to the Senior Director of Medical Management or Medical Director. + Appropriately identifies potential cases for Care … more