• ABA Utilization Review (UR)…

    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 ... clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and...+ Flexible work environment - You can work from home , hybrid or fully in office. + Competitive Salary… more
    Spectrum Billing Solutions (11/16/24)
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  • Utilization Review Specialist - PRN

    Munson Healthcare (Traverse City, MI)
    …interdisciplinary team members, payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? + Our dynamic work ... appropriateness for inpatient level of care or observation services based on documented condition plan of treatment and care....+ Minimum of three years clinical experience required. Previous utilization review and/or case management in a… more
    Munson Healthcare (11/09/24)
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  • Medical Director of Utilization

    Henry Ford Health System (Detroit, MI)
    The Medical Director of Utilization Review is responsible for the medical oversight of activities related to appropriateness of Henry Ford Hospital (HFH) ... and continued stays of inpatients. The Medical Director of utilization review will ensure the most efficient...and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and… more
    Henry Ford Health System (11/06/24)
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  • Utilization Review Specialist Senior

    BayCare Health System (Clearwater, FL)
    …responsibility and clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our outstanding and ... the Tampa Bay area. Our network consists of 16 community- based hospitals, a long-term acute care facility, home...compassionate team. **The Utilization Review Specialist Senior responsibilities include:** +… more
    BayCare Health System (10/14/24)
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  • Utilization Management Coordinator…

    Sanford Health (ND)
    …28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an… more
    Sanford Health (11/21/24)
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  • Utilization Review Clinician…

    Centene Corporation (Madison, WI)
    …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... role have the flexibility to work remotely from their home anywhere within the Eastern or Central time zone...or Central time zone **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
    Centene Corporation (11/21/24)
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  • Manager, Care Coordination - Utilization

    Stanford Health Care (Palo Alto, CA)
    …and Abilities** + Knowledge of principles and best practices of case management, utilization review , social work, care coordination and discharge planning. + ... growth and work-life balance while honoring its commitment to delivering evidence- based and patient-centered care. We are seeking a results-driven manager to… more
    Stanford Health Care (11/20/24)
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  • Utilization Review Social Worker

    HCA Healthcare (Ogden, UT)
    …Apply Today! **Job Summary and Qualifications** The Mental Health Professional/ Utilization Review role primarily involves reviewing medical records ... guidelines. Participates in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with Process and Quality… more
    HCA Healthcare (10/31/24)
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  • Support Specialist- Utilization

    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. ... payers as needed. * Maintain a current knowledge of Utilization Management through interaction with staff and payor portal...and specialty care, health insurance, a full suite of home health offerings, virtual care, pharmacy, eye care and… more
    Henry Ford Health System (11/20/24)
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  • Utilization Management Director (Hybrid)

    CareFirst (Baltimore, MD)
    …detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services. ... expected to work a portion of their week from home and a portion of their week at a...Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience.… more
    CareFirst (11/26/24)
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  • Medicaid Utilization Analyst 9-12 - Bphasa…

    State of Michigan (Lansing, MI)
    Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES SECTION Print (https://www.governmentjobs.com/careers/michigan/jobs/newprint/4741189) Apply  ... Medicaid Utilization Analyst 9-12 - BPHASA MEDICAL EQUIPMENT & SERVICES... Analyst 12 This position functions as a clinical review professional responsible as the senior analyst conducting clinical… more
    State of Michigan (11/25/24)
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  • Manager, Utilization Management Operations-…

    VNS Health (Manhattan, NY)
    …general supervision. Compensation Range:$98,200.00 - $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing ... by assigned staff or through contract relationships in both home and community- based settings. * Manages and...Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with… more
    VNS Health (10/09/24)
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  • Utilization Management Nurse Consultant

    CVS Health (Austin, TX)
    …Suite (PowerPoint, Word, Excel, Outlook) Preferred Qualifications: + 1+ years' experience Utilization Review experience + 1+ years' experience Managed Care + ... care more personal, convenient and affordable. Position Summary: This Utilization Management (UM) Nurse Consultant role is fully remote...is a late shift requirement until 8:00pm EST approximately based on needs of business.** **There is a weekend… more
    CVS Health (11/21/24)
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  • Post Acute Utilization Management Nurse…

    Humana (Boise, ID)
    …and independent determination of the appropriate courses of action. The Post-Acute Utilization Management Nurse 2: + Review cases using clinical knowledge, ... part of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination,… more
    Humana (10/29/24)
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  • Utilization Management RN (mostly remote)

    VNS Health (Manhattan, NY)
    …subject matter experts, physicians, member representatives, and discharge planners in utilization tracking, care coordination, and monitoring to ensure care is ... general supervision. Compensation Range:$85,000.00 - $106,300.00 Annual * Conducts comprehensive review of all components related to requests for services which… more
    VNS Health (11/05/24)
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  • Utilization Management Behavioral Health…

    Humana (Columbus, OH)
    …and external customers and stakeholders. **Preferred Qualifications** + Experience with utilization review process. + Experience with behavioral change, health ... first** Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral...the spring. However, this may be subject to change based on business needs. **Work at Home more
    Humana (11/13/24)
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  • Utilization Reviewer Coordinator

    Wellpath (Fort Lauderdale, FL)
    …and point of care support. **How you make a difference** The Utilization Review Coordinatorwill perform admission and continued-stay reviews. This position ... discounts * Preferred banking partnership and discounted rates for home and auto loans *Eligibility for perks and benefits...inpatient preferred. + Minimum one (1) year clinical or utilization review or case management preferred. +… more
    Wellpath (11/22/24)
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  • Utilization Management Nurse Consultant

    CVS Health (Columbus, OH)
    …**ed Qualifications** + **Critical care experience ie ICU, CCU, NICU, ER** + Utilization review experience + Managed Care experience + Experience working with ... and affordable. **Position Summary** ​ **This is a fulltime remote Utilization Management opportunity.** **The schedule is Monday through Friday, 8am-5pm in… more
    CVS Health (11/21/24)
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  • Clinical Home Care Quality Review

    Trinity Health (Livonia, MI)
    home care and end-of-life care in the sacred place that people call home . A Catholic- based , non-profit organization, we serve patients and their loved ones ... within 6 months of hire. HCS-O is helpful. Remote position. **Clinical Quality Review Specialist Position Summary - REMOTE** **RN Must be certified in HCS-D to… more
    Trinity Health (11/22/24)
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  • Home Health Clinical Manager FL…

    HCA Healthcare (Nashville, TN)
    …are celebrated for being on the front line, empathetic for patients. At Work from Home our nurses set us apart from any other healthcare provider. We are seeking ... in FL and requires some travel.** **Benefits** Work from Home , offers a total rewards package that supports the...a 100% match on 3% to 9% of pay ( based on years of service) + Employee Stock Purchase… more
    HCA Healthcare (11/13/24)
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