- International Medical Group (Indianapolis, IN)
- …large case management cases by diagnosis, dollar amount and/or high utilization of medical services and refer those identified for large case management ... of the use of health care services, procedures, and facilities for utilization review and /or /evacuation/repatriation. Work as a liaison between the Insured,… more
- Prime Therapeutics (Indianapolis, IN)
- …post-degree clinical experience. + Experience in managed care, specialty drugs, care management and utilization review. + Meets Magellan Credentialing criteria. ... and drives every decision we make. **Job Posting Title** Infusion Referral Nurse - REMOTE **Job Description Summary** Under supervision, is responsible for performing… more
- Sharecare, Inc. (Indianapolis, IN)
- …open enrollment / new hire plan selection, claims issues, ID card issues, grievances/ appeals , utilization management (UM) status, including but not limited ... 3rd parties for: + Claims adjustments + Grievances and appeals submissions + Utilization management ...and second opinion. + Referring members to Clinical Advocates ( Nurse ) for conditions that require clinical care and case… more
- Sedgwick (Indianapolis, IN)
- …and consult review; and two (2) years of experience in daily application of nurse auditing, utilization review and bill review. **Skills & Knowledge** + ... providers including complex hospital, surgical, high level evaluation and management codes and/or technical bills. **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** +… more