- CVS Health (Frankfort, KY)
- …it all with heart, each and every day. **Position Summary** This is a fully ** remote ** Utilization Review Clinical Consultant. **Must reside in the state of ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Remote PRN Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization… more
- Martin's Point Health Care (Portland, ME)
- …2015. Position Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, ... organizational determinations/ disputes, and auditing/training of utilization review staff. Regularly monitors daily workload, volumes, metrics, production, and… more
- Actalent (San Antonio, TX)
- …complete cases. Qualifications: + 3+ years of utilization management, concurrent review , prior authorization, utilization review , case management, and ... Immediate Hiring for " Remote Clinical Review Nurses" Job Description: + Review approximately 20 cases a day for medical necessity. + Advocate for and protect… more
- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Epic preferred. Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code: Not Applicable… more
- CVS Health (Phoenix, AZ)
- …+ Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . ** Remote Work Expectations** + This is a 100% ... + Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes +… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... times may vary based on business needs. Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... 8:00am-5:00pm EST (Shift times vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division… more
- Integra Partners (Troy, MI)
- …operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but are not… more
- Highmark Health (Bismarck, ND)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Spectrum Billing Solutions (Skokie, IL)
- …in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Springfield, IL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... experience in various mental health settings especially inpatient behavioral health units, utilization management / review , and youth or pediatric services.**… more
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but are not… more
- Novant Health (NC)
- What We Offer Why This Role Matters As a Utilization Review Clinician, you will play a critical role in ensuring the integrity and compliance of patient health ... required. + Serve as a leader resource in the Utilization Review process for Behavioral Health acute...or related experience. What's In It for You + Remote work opportunity, equipment provided. + Daytime hours. +… more
- Centene Corporation (Phoenix, AZ)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... care in accordance with ABA guidelines. This is a remote position however must reside in Arizona. + Evaluates...Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers… more
- Centene Corporation (Madison, WI)
- …weekend / holiday coverage. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team ... to ensure appropriate care to members. Supervises day-to-day activities of utilization management team. + Monitors and tracks UM resources to ensure adherence to… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... Summary** This Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state. **Normal Working Hours: Monday… more
- CVS Health (Austin, TX)
- …care experience is in behavioral health) **Preferred Qualifications** + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... with heart, each and every day. **Position Summary** This Utilization Management (UM) Nurse Consultant role is 100% ...Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.… more
- Humana (Frankfort, KY)
- …and integrated care needs for those with autism + Prior experience with Utilization Review , Utilization Management, Peer Reviews and/or Quality Management ... of our caring community and help us put health first** The Utilization Management Behavioral Health Professional 2 utilizes behavioral health knowledge and skills… more