- Elevance Health (Norfolk, VA)
- **Title:** Licensed Utilization Review II **Location** : This position will work a remote model, but candidates must live within 50 miles of one of our ... : 4 weekdays and 1 weekend day as discussed with manager. The ** Licensed Utilization Review II** is responsible for working primarily with healthcare… more
- Elevance Health (Louisville, KY)
- The ** Licensed Utilization Review I** is responsible for working with healthcare providers to help ensure appropriate and consistent administration of plan ... diploma or equivalent and a minimum of 2 years of clinical or utilization review experience; or any combination of education and experience, which would provide… more
- Kelsey-Seybold Clinic (Pearland, TX)
- …as facilitator of communication with clinic, payor and other customers. **Job Title: Licensed Vocational Nurse Utilization Review -** ** Utilization ... **Responsibilities** The Utilization Review LVN nurse will perform documentation review for medical necessity and benefit correlation of requested medical… more
- The Arora Group (Bethesda, MD)
- Licensed Practical Nurse (LPN) - Utilization Review Nurse Currently recruiting a Licensed Practical Nurse (LPN/LVN) - Utilization Review in ... holidays. DUTIES OF THE LICENSED PRACTICAL NURSE (LPN/LVN) - UTILIZATION REVIEW : + Initiate, perform and complete assigned duties in providing care to… more
- Molina Healthcare (Bowling Green, KY)
- …are seeking a Registered Nurse or Licensed Social Worker with PSYCH / BH Utilization Review / Utilization Management and knowledge of Interqual / MCG ... or ER unit. **Preferred License, Certification, Association** Active and unrestricted Licensed Clinical Social Worker To all current Molina employees: If you… more
- Covenant Health Inc. (Louisville, TN)
- Overview Utilization Review Coordinator, Quality Management Full Time, 80 Hours Per Pay Period, Day Shift Peninsula Overview: Peninsula, a division of Parkwest ... or retrospective utilization data. + Monitors current utilization review criteria and length of stay...duties as required. Qualifications Minimum Education: RN License or Licensed Therapist from an accredited program Minimum Experience: At… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …resources and benefits on a case by case basis. Applies case management and utilization review principles in monitoring the delivery of care and promoting ... planners regarding transition to alternative levels of care. + Perform concurrent utilization review applying identified criteria at prescribed review … more
- Mount Sinai Health System (New York, NY)
- **Job Description** The Utilization Review Manager for the Selikoff Centers for Occupational Health is responsible for the management of program operations ... records, and internal and external regulatory and survey requirements. + The Utilization Review Manager collaborates with multiple professionals to support and… more
- Centene Corporation (Raleigh, NC)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... and procedures. + Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all mandatory learning… more
- Ascension Health (Manhattan, KS)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- SUNY Upstate Medical University (Syracuse, NY)
- Job Summary: This Utilization Review Denials Review Unit (DRU) 3 Team Lead will assist the Director of Utilization Review and the Associate Director ... of Utilization Review with daily staff mentoring, leadership and resource provision....for committees. Other duties as assigned. Minimum Qualifications: NYS Licensed /Registered (or eligible) RN required. Bachelors degree in Nursing… more
- Ascension Health (Austin, TX)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Trinity Health (Fort Lauderdale, FL)
- **Employment Type:** Part time **Shift:** **Description:** The Utilization Review (UR) Nurse has well-developed knowledge and skills in areas of utilization ... requirements of various commercial and government payers. On-Site Position** **_Position Purpose:_** Utilization Review (UR) Nurses play a vital role in… more
- HCA Healthcare (Ogden, UT)
- …Apply Today! **Job Summary and Qualifications** The Mental Health Professional/ Utilization Review role primarily involves reviewing medical records ... in developing department goals and clinical programming. + Performs utilization review as assigned. + Helps with...Social Worker (BCSW), or Clinical Mental Health Counselor, or Licensed Clinical Social Worker (LCSW), or Licensed … more
- Ascension Health (Nashville, TN)
- …Provide health care services regarding admissions, case management, discharge planning and utilization review . + Review admissions and service requests ... planning needs with healthcare team members. + May prepare statistical analysis and utilization review reports as necessary. + Oversee and coordinate compliance… more
- Travelers Insurance Company (Buffalo, NY)
- …**What Is the Opportunity?** This position is responsible for conducting in-house utilization review with emphasis on determining medical necessity for ... to the compensable injury and for adhering to multi-jurisdictional Utilization Review criteria. **What Will You Do?**...preferred. **What is a Must Have?** + Registered Nurse; Licensed Practical Nurse or Licensed Vocational Nurse… more
- Trinity Health (Mason City, IA)
- …Monday-Friday 0630-1430; no weekends or holidays **About The Job** The Utilization Review Case Manager responsibilities include case screening, insurance ... disciplines. **What We Are Looking For** Education [formal]: + Licensed registered nurse in the state of Iowa. +...of Iowa. + Bachelor's Degree required. BSN preferred + Utilization management focused certifications that are recognized in the… more
- Mohawk Valley Health System (Utica, NY)
- RN - Utilization Review Nurse - Full Time - Days Department: CASE MANAGEMENT Job Summary Reports to and is under direct supervision of Case Management ... compliance. Education/Experience Requirements Required: + Minimum of two (2) years utilization review /case management experience or social work experience.… more
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