- Altru Health (East Grand Forks, MN)
- …in restructuring of current and new programs. Performs utilization review when required. Collaborates with Primary Care Provider (PCP) regarding ... information with each patient. Assesses the patient to identify needs, issues, care goals, termination and continuing care options. Completes psychosocial… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members who may have complex healthcare ... following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part...understanding of clinical management, trends in patient care , utilization management and other topics applicable… more
- Adelante (Goodyear, AZ)
- …health outcomes reporting, clinical audits, and programmatic evaluation + Help evaluate clinical care , utilization of resources, and development of new ... Clinical Registered Dietitian II - Goodyear Job Details...for assessing the nutritional status and developing evidence-based nutrition care plans for patients across the lifespan with various… more
- MetroHealth (Cleveland, OH)
- …that appropriate and necessary healthcare services are covered by insurance. Reviews clinical criteria to support patient care inquiries regarding the ... set and Milliman Health Management Guidelines. Current working knowledge of, utilization management, case-management, performance improvement, and managed care … more
- Wellpath (Fort Lauderdale, FL)
- …point of care support. **How you make a difference** The Utilization Review Coordinatorwill perform admission and continued-stay reviews. This position also ... a very large percent of those individuals receive direct clinical care , which includes lives saved by...setting, preferably inpatient preferred. + Minimum one (1) year clinical or utilization review or… more
- AnMed Health (Anderson, SC)
- … Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of the ... utilization management team, and provides timely medical ...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Kepro (AR)
- …on review of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. + Clinical quality ... vital partner for health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN (Remote within Arkansas) ** The… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...care managers and believe that coordinating high quality clinical and social services will result in better … more
- Trinity Health (Livonia, MI)
- **Employment Type:** Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect and ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with...perioperative nursing or experience in analyzing and interpreting process, clinical outcomes and costs of care . +… more
- RWJBarnabas Health (Newark, NJ)
- …Israel Medical Ctr, 201 LYONS AVENUE, NEWARK, NJ 07112-2027 JobTitle: Clinical Reviewer Location:Newark Beth Israel Req#:0000156276 Status:Full-Time Shift:Day ... in high-quality patient care , education, and research to address both the clinical and social determinants of health. RWJBarnabas Health aims to truly make a… more
- Hartford HealthCare (Hartford, CT)
- … and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable ... **Administrative* **Organization:** **Hartford HealthCare Medical Group Specialists* **Title:** *Surgical Clinical Reviewer - General Surgery* **Location:** *Connecticut-Hartford-85… more
- Chenega Corporation (NM)
- …a **Chenega Professional Services** ' company, is looking for a fully remote ** Clinical Quality Reviewer ** to ensure compliance with the contract, and program ... requirements for Clinical Quality Management (CQM) within TRICARE West Region. To...review as appropriate to Program Integrity, Case Management, Care Coordination, Population Health Improvement, Disease Management, Congressional Relations… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service...order to participate in panel appeals + Experience in Utilization Management in a managed- care environment (as… more
- AdventHealth (Maitland, FL)
- …addressing areas of need.Collaborates with Senior Medical Officers with contracted managed care payers regarding utilization review management activities and ... efficiency in the inpatient setting.Performs other duties as assigned.Develops clinical care pathways and utilization ...the organization and collaborates with all levels of managed care team, utilization review management,… more
- Magellan Health Services (Honolulu, HI)
- …Hawaii. Under general supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of mental health and ... substance abuse services provided in inpatient and/or outpatient care settings. Collects and analyzes utilization data....of care . General Job Information Title HMSA Care Manager - BH, UM Reviewer -… more
- The Cigna Group (Bloomfield, CT)
- …in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality assurance/improvement, ... clinical protocols; and authorizing coverage of services or referring requests for expert clinical review as appropriate. + Be available as an expert advisor… more
- Kepro (AR)
- …Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver ... partner for health solutions in the public sector. Acentra seeks a Dental Hygienist Reviewer to join our growing team. Job Summary: The Dental Hygienist Reviewer … more
- Medical Mutual of Ohio (OH)
- …work at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + ... implements, and documents, discharge planning activities based on the members' specific clinical condition, health plan benefits, and optimal care delivery. Acts… more
- Elevance Health (San Juan, PR)
- …providing information technology and business operations services for health plans._ **Nurse Reviewer I** **Location:** This position will work a hybrid model (1-2 ... US States time zones that the unit will be supporting. The **Nurse Reviewer I** is responsible for conducting preauthorization, out of network and appropriateness of… more
