- AmerisourceBergen Drug Corporation (Conshohocken, PA)
- …serialization phase in, and establishing a product serialization label review processes.Primary Duties and Responsibilities:Manage the overall Cencora inbound DSCSA ... to ensure all the Cencora businesses can support the phase in of medical devices containing the new UDI identifier; includes identification of any projects and… more
- UNC Health Care (Rocky Mount, NC)
- …in healthcare/ medical - acute care (acute hospital setting) + 0-2 healthcare/ medical - - utilization review (or other healthcare-related experience) ... Carolina license without sanctions)** Preferred Certifications & Licensures + Utilization Review or other applicable certification **Professional Experience… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing...want to promote within our team. + Benefits - Medical , Dental, Vision + Flexible Paid Time Off -… more
- Independent Health (Buffalo, NY)
- …Collaborative and Accountable. **Essential Accountabilities** + Provide high quality, professional utilization management services: ( medical necessity review ... first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to determine the … more
- Trinity Health (Maywood, IL)
- …of the Director/Manager oversees the daily caseloads of the UR/UM teams. This includes utilization review of inpatient medical and behavioral health services ... quality of care, mitigate cost trends through supporting optimization of utilization review for medical necessity using established care guidelines and… more
- St. Luke's University Health Network (Allentown, PA)
- …incorrect registrations and/or physician queries + Serves as liaison between Physician Advisor/ Medical Director, Finance, Utilization Review Department and ... Conducts reviews of cases lost with feedback to respective departments + Conduct concurrent review with utilization review department for post op surgical… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …identified concerns to the treatment team, Director of Utilization Management, and the Medical Director. + Review charts at identified review points and ... resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting… more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed ... level case work for Cigna Healthcare (CHC) **Summary description of position** : A Medical Principal performs medical review and case management activities.… more
- Lancaster General Health (Lancaster, PA)
- …to clinical services provided by the Hospitalists, quality improvement, education of staff, medical and utilization review and feedback, and support for ... **Summary** **Job Description** **POSITION SUMMARY:** The Associate Medical Director, Hospitalist Services is responsible for assisting the Medical Director,… more
- US Tech Solutions (Columbia, SC)
- …practices. + May provide any of the following in support of medical claims review and utilization review practices: Performs medical claim reviews ... sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that...indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization… more
- The Cigna Group (Bloomfield, CT)
- …by a supervisor in Utilization Management. Handles moderately complex medical review , utilization review , credentialing/re-credentialing, quality ... appropriate course of action for treatment. May analyze treatment patterns and utilization trends. Contributes to the development and implementation of action plans… more
- The Cigna Group (Bloomfield, CT)
- … utilization and financial initiatives. Responsible for program execution and drives utilization review medical program management for specific clinical ... Description SummaryGuides the company on strategic Utilization Review decisions and provides medical advice that... Utilization Review decisions and provides medical advice that has a significant impact on strategic… more
- ManpowerGroup (Columbia, SC)
- …+ Strong understanding of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency ... in the state of hire. **Job Description:** As a Medical Claims Reviewer/ Utilization Management Specialist, you will... determinations. + Review interdepartmental requests and medical information efficiently to complete the utilization … more
- The Cigna Group (Bloomfield, CT)
- …Business Title: Medical Director, Durable Medical Equipment Cigna Title: Utilization Review Medical Principal II. Department Name and Number: Product ... Summary: The Medical Director provides timely expert medical review of medical necessity...necessity requests for clinical services that do not meet utilization review criteria and renders a clinical… more
- Molina Healthcare (Lexington, KY)
- …SKILLS & ABILITIES:** + Minimum 3 years clinical nursing experience. + Minimum one year Utilization Review and/or Medical Claims Review . + Minimum two ... DESCRIPTION** **Job Summary** Utilizing clinical knowledge and experience, responsible for review of documentation to ensure medical necessity and appropriate… more
- AdventHealth (Orlando, FL)
- …home health. Related functions include but are not limited to performance of medical record review , utilization management, patient safety, compliance ... well as addressing bill hold items related to the medical record review and quality process as...use of comparative data, performance of specified audits and utilization management activities. + Serves as a resource to… more
- Sharp HealthCare (San Diego, CA)
- …all accounts in rep assignment or alpha split. Contact hospital departments such as Medical Records, Utilization Review or external review organizations ... all necessary attachments required for billing (ie hard copy authorizations, medical records. 18-1. 50-1. etc.).Assures billing compliance standards are metCheck DDE… more
- Logan Health (Whitefish, MT)
- …reviews and appeals, and executes contract requirements. E. Participates in the medical staff committee utilization review functions including education, ... the multidisciplinary team in the daily patient report meeting. II. Provides Utilization Review services to NV: Monitors resource consumption, census levels,… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …for medical and surgical procedures, services and admissions. The Utilization Review Specialist communicates with providers regarding pertinent information ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible...**Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting ...needed for medical review to ensure service decisions are… more
- Hackensack Meridian Health (Hackensack, NJ)
- **Overview** The Senior Utilization Review Specialist collaborates with the healthcare team in the management and resolution of activities that assure the ... patient population and HackensackUMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and… more
