- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... more
- Saint Luke's (Kansas City, MO)
- … RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position ... more
- Vanderbilt University Medical Center (Lebanon, TN)
- …that the appropriate admission status is ordered. Conducts initial admission based on utilization review medical necessity criteria. Refers cases for ... more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... more
- Prime Healthcare (Joliet, IL)
- …licensure. #LI-MP2 Connect With Us! (https://careers-primehealthcare.icims.com/jobs/203251/ medical - review -coordinator-i utilization ... more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... more
- Catholic Health Initiatives (Omaha, NE)
- …for our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! ... more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... more
- Elevance Health (Norfolk, VA)
- …service operations and other internal departments. + Responsibilities exclude conducting any utilization or medical management review activities which ... more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... more
- The Cigna Group (Bloomfield, CT)
- …not be included in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed ... more
- ManpowerGroup (Columbia, SC)
- …to effectively communicate with members and healthcare providers. **Key Responsibilities** ✔ ** Medical Review & Utilization Management (80%)** + Perform ... more
- AmeriHealth Caritas (Newtown Square, PA)
- …programs to document and assess patient cases efficiently. + Strong understanding of utilization review processes, including medical necessity criteria (eg ... more
- Banner Health (Phoenix, AZ)
- …delivery, focusing on value-based care, risk recapture, and quality outcomes. This role includes medical case review , utilization , and quality review , ... more
- SUNY Upstate Medical University (Syracuse, NY)
- …patients, maintaining accurate attendance and therapy records. Interfaces with nursing, medical staff, utilization review social services, discharge ... more
- MyFlorida (Miami, FL)
- …analysis activities. Skilled in the techniques of oral communication and methods of utilization review ; knowledge of complex medical terminology; ability to ... more
- Public Storage (Plano, TX)
- …+ Oversee reporting of claims and compliance with state filing requirements + Oversee medical utilization + Review and analyze all claims; identify claims ... more
- Hackensack Meridian Health (Hackensack, NJ)
- …including Hospitalists, to ensure appropriate length of stay, time of day discharge, medical chart completion, and utilization review . **Regulatory Affairs** ... more
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