- Merck & Co. (Los Angeles, CA)
- …care (transition of care) using approved messages and resources-Conducts appropriate business review of account performance to optimize net sales for our Company ... to the Customer including promotional positioning (support of appropriate utilization ) and/or provider quality and outcomes-based activities.Provides feedback to and… more
- Centene (Florissant, MO)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... competitive benefits including a fresh perspective on workplace flexibility. **POSITION IS REMOTE BUT MUST RESIDE IN STATE OF MISSOURI** CANDIDATES WITH FOSTER CARE… more
- Centene (Shawnee, OK)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... competitive benefits including a fresh perspective on workplace flexibility. Position is REMOTE but candidate must reside in STATE of OKLAHOMA Position Purpose:… more
- Centene (Keizer, OR)
- …perspective on workplace flexibility. 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. (Location must reside in Oregon) Monitors and tracks UM… more
- Aequor (New York, NY)
- …York State Prefer minimum of 1-3 years relevant experience in case management, utilization review and/or quality assurance Experience in acute episodic care, ... Contractor Position (First 6 months- 5 days onsite, then 4 days/week onsite and 1 day remote ) 8:30 AM to 4:30 PM (Monday - Friday) New York Headquarters - 66 Hudson… more
- Centene (Wabasha, MN)
- …States** Position Purpose: Act as a subject matter expert (SME) in the utilization review and authorization of Durable Medical Equipment (DME) consistent with ... therapy practice and/or outpatient occupational, physical and speech therapy. Review for the medical necessity and appropriateness of Durable Medical Equipment based… more
- Albany Medical Center Careers (Delmar, NY)
- …changing environment.8. Basic knowledge of computer systems with skills applicable to utilization review process.Mission, Core Values and Service Excellence 1. ... with the Quality Improvement Teams, patient care standards, Social Work, and utilization management to coordinate the appropriate use of resources to achieve maximum… more
- Centene (Brusly, LA)
- …with network practitioners to provide education on best practice models and utilization management processes Interact with the Medical Director, or designee, to ... and member complaints related to psychological testing or other services requiring review by a PhD/PsyD Facilitate outpatient rounds offering clinical input and… more
- Saint Francis Health System (Tulsa, OK)
- …Time7p - 7aVirtual Nurse works from an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care ... toward goals. Facilitates patient discharge through timely, appropriate referrals and utilization of patient education resources, suitable to patient age and… more
- CVS Health (Raleigh, NC)
- …training, position is remote with occasional in office requirement. Utilization Review - Precertification Nurse is responsible for telephonically assessing, ... care innovators. Fundamentals:Through the use of clinical tools and information/data review , conducts an evaluation of member's needs and benefit plan eligibility… more
- Henry Ford Health System (Detroit, MI)
- …+ Innovative Team Structure:Benefit from our new dyad Social Work/RN Case Manager model and remote utilization review setup, allowing you to excel in your ... transition to the next level of care seamlessly. Perks of the Role: + Remote Flexibility:After 6 months, enjoy the option to work weekends and holidays remotely with… more
- Pipeline Health System, LLC (Gardena, CA)
- …transfer processes and escalations. The Patient Hub Transfer Coordinator works closely with the remote Utilization Review (UR) Nurses to assure the patient ... meets inpatient status prior to accepting the transfer. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET… more
- Kepro (Indianapolis, IN)
- …Acentra seeks a Utilization Management (UM) Nurse Clinical Reviewer - LPN/RN ( Remote US) to join our growing team. Job Summary: The purpose of this position ... is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with...or Bachelor's Degree Nursing Program. + 2+ years of Utilization Management (UM) experience from the State, Hospital, or… more
- Kepro (Los Angeles, CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a Utilization ... for ensuring the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental Health Services… more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Position Overview: As a Utilization Reviewer, you involves reviewing medical records against appropriate criteria and ... ensures the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process with the California Mental Health Services Authority (CalMHSA).… more
- Insight Global (New York, NY)
- …. Skills and Requirements - Valid Compact RN License - 4-5 years of Remote Utilization Management experience at Payors, inpatient or outpatient - Proficiency ... Job Description Insight Global is looking for a Pre-Access Utilization Management Registered Nurse to sit remotely with one of their large health insurance clients.… more
- University of Virginia (Charlottesville, VA)
- Inpatient and Outpatient Setting. Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management process. They ... RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management activities are performed in accordance with the mission vision… more
- Centene Corporation (Topeka, KS)
- …insight and guidance on the review of member medical records to the utilization review BH team + Provides guidance and expert knowledge as appropriate to ... the behavioral health utilization review team members to ensure the...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Children's Hospital Boston (Boston, MA)
- 76071BRJob Posting Title:RN Case Manager, Utilization Review , Case Management UM/UR (24 hrs)Department:Patient Services-Patient Care ... OperationsAutoReqId:76071BRStatus:Part-TimeStandard Hours per Week:24 Job Posting Category:NursingJob Posting Description:The Utilization Review Nurse will be responsible for:… more
- CareFirst (Baltimore, MD)
- …assisting with non-clinical administrative tasks and responsibilities related to pre-service, utilization review , care coordination and quality of care. ... Reviews authorization requests for initial determination and/or triages for clinical review and resolution. + Provides general support and coordination services for… more
