- New York State Civil Service (Queens Village, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), Creedmoor Psychiatric Center, P25684 Occupational Category Health ... City Queens Village State NY Zip Code 11427 Duties Description As a Utilization Review Coordinator, your duties will include:* Reviewing clinical records for… more
- New York State Civil Service (Bronx, NY)
- NY HELP Yes Agency Mental Health, Office of Title Utilization Review Coordinator, (NY HELPS), New York City Children's Center - Bronx Campus, P25595 Occupational ... New York City Children's Center - Bronx Campus is recruiting for a Utilization Review Coordinator to analyze and evaluate quality, effectiveness, and efficiency… more
- Intermountain Health (Murray, UT)
- …+ Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and Analysis:** ... will apply expertise in Applied Behavior Analysis (ABA) to review medical records and treatment plans for...in behavioral health. + Knowledge of healthcare insurance and utilization review processes. + Excellent communication and… more
- CVS Health (Columbus, OH)
- …**Required Qualifications:** -3+ Years of clinical experience -1+ Year of Utilization Review Management and/or Medical Management experience. ... US. **Schedule is Monday - Friday 8am-5pm est.** No travel required. Non-exempt. Hourly. Pay: Bi-weekly. No shift premium....a collaborative process to implement, coordinate, monitor and evaluate medical review cases . Applies the appropriate… more
- Health Advocates Network (Medford, OR)
- Health Advocates Network is urgently hiring Discharge Planning and Utilization Review Registered Nurses (RNs) in the Medford, OR area. Must have 2 years of ... Discharge Planning and Utilization Review experience. * Pay Rate: $2,608...opportunities. Benefits We Offer: Competitive pay rates, Referral Bonus, Medical , Dental, Vision and 401k. Travel reimbursement… more
- Trinity Health (Des Moines, IA)
- …**Shift:** **Description:** **_Are you an experienced Director of Care Management & Utilization Review looking for an interim assignment? Join Trinity Health ... $1300.00 Tax Free weekly Stipend or Trinity Health Pays Travel and Lodging._** **_ This is a non benefited...for the entire scope of Care Coordination for MercyOne Medical Center and MercyOne West Des Moines. Operational responsibilities… more
- Excellus BlueCross BlueShield (Dewitt, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and… more
- Huron Consulting Group (Chicago, IL)
- …our team as the expert you are now and create your future. The Talent Utilization Coordinator will serve as the lead for managing staffing and utilization across ... role is a Manager or Sr. Manager. Responsibilities: 50% Utilization * Oversee activities supporting persona: * Utilization...to conduct initial reviews of pricing tools from Risk Review , ensuring that all pricing strategies are viable and… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... **Details** + **Department:** Utilization Management + **Schedule:** Monday - Friday. 40...**Location:** Remote - Nashville, TN. This position requires occasional travel to Ascension Saint Thomas hospitals throughout the TN… more
- McLaren Health Care (Detroit, MI)
- … records/billing or healthcare related field + Two years of case management or utilization review , billing, or coding experience + Three years of recent ... determine the appropriate hospital setting (inpatient vs. observation) based on medical necessity. 2. Performs concurrent and retrospective utilization … more
- CoreCivic (Brentwood, TN)
- …TN office location._ The Utilization Management/Case Management Nurse provides Utilization Review and Case Management functions for the organization under ... in planning care. Creates plan for care across the continuum. + Performs utilization review ensuring admissions meet criteria for appropriateness of care and… more
- Humana (Columbus, OH)
- …problem-solving skills, facilitation skills **Preferred Qualifications** + Experience with utilization review process + Experience with behavioral change, ... and skills to support the coordination, documentation, and communication of medical services and/or benefit administration determinations. The Utilization … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …external facility or providers as needed to gather clinical information to support the medical necessity review process and plan of care. + Support a positive ... Conduct pre-certification, concurrent, and retrospective reviews with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and… more
- Humana (Columbus, OH)
- …medical services and/or benefit administration determinations. The Manager, Utilization Management Behavioral Health works within specific guidelines and ... our caring community and help us put health first** The Manager, Utilization Management Behavioral Health utilizes behavioral health knowledge and skills to support… more
- Katmai (Usaf Academy, CO)
- …need for inpatient/outpatient precertification. **ESSENTIAL DUTIES &** **RESPONSIBILITIES** + Review precertification requests for medical necessity, referring ... Medical Director those that require additional expertise. + Review clinical information for concurrent reviews. + As part...Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,… more
- Sharp HealthCare (San Diego, CA)
- …with 0-2 errors; Have the ability to proof work.Knowledge of insurance, utilization review , scheduling requirements and support of front desk ... administered including two (2) patient identifier verification. Assists with Medical Assistant medication verification in immediate area. No medication errors.Able… more
- Molina Healthcare (San Jose, CA)
- …Experience** Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… more
- Molina Healthcare (Columbus, OH)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in United States who has a compact, multi-state license. This team reviews the prior ... requests for transplants; the ideal candidate will have experience either in utilization review or case management for transplants. Preference will be… more
- Molina Healthcare (MS)
- …license in good standing, such as LCSW, LPCC or LMFT (for Behavioral Health Care Review Clinicians only). Must be able to travel within applicable state or ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- The Estee Lauder Companies (Miami, FL)
- Estee Lauder Companies Travel Retail Americas is looking for their next Corporate Account Manager **Description** The key objectives of this role is to manage and ... ⁃ Provide feedback to Store Design to maximize the utilization of the space and maintain the brand image...duty free environment ⁃ Mobile, energetic and willing to travel up to 60 % of time ⁃ Self… more