- Martin's Point Health Care (Portland, ME)
- …Point has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as a member of a team responsible for ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...requests (prior authorization, concurrent review , and retrospective review ) for medical necessity referring to Medical Director… more
- UPMC (Hanover, PA)
- **UPMC is hiring a Professional Care Manager to support the Utilization Review process! This is a full time, day shift position with a rotating weekend and ... holiday schedule.** This is a nonpatient-facing position. This Registered Nurse is responsible for completing medical necessity reviews utilizing Indicia and… more
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- WellSpan Health (York, PA)
- … utilization management, denials and Prior Authorization activities to ensure utilization review activities are conducted timely in accordance with internal ... Director - Utilization and Denials Management Location: WellSpan...Serves as point of contact for System acute care utilization review issues and resolutions with payers.… more
- CareFirst (Baltimore, MD)
- …detail can be shared during the interview process. Plans, organizes, and manages utilization review programs. Directs the utilization of referral services. ... Upon Hire Required. **Experience:** 8 years' Experience in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** +… more
- Ascension Health (Nashville, TN)
- …initiatives. + Develop systems and processes for prospective, concurrent and retrospective utilization review for allself-funded and fully insured clients to ... Ascension Saint Thomas hospitals throughout the TN market. We're looking for an experienced Director of Utilization Management to join our team! In this pivotal… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …* Adaptive to a high pace and changing environment. * Proficient in Utilization Review process including benefit interpretation, contract language, medical and ... Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse - Prior Authorization performs medical necessity reviews… more
- Prime Healthcare (Ontario, CA)
- …Clinical Utilization Management (UM) provides comprehensive oversight of the Utilization Review process for the self-insured Employee Health Plans, according ... needs. + Provides strategic leadership, development, and supervision to utilization review department, provides interprofessional collaboration with… more
- Katmai (Usaf Academy, CO)
- …Review precertification requests for medical necessity, referring to the Medical Director those that require additional expertise. + Review clinical ... Minimum of two (2) years of prior experience in Utilization Management. + Must possess a current, active, full,...licensed in Colorado, be able to practice using a nurse compact state license or have a license from… more
- CVS Health (Phoenix, AZ)
- … Utilization Management experience within an Inpatient/Outpatient setting, concurrent review or prior authorization. + 5+ years of variety clinical experience ... AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support… more
- Hackensack Meridian Health (Belle Mead, NJ)
- …to the treatment team, Director of Utilization Management, and the Medical Director . + Review charts at identified review points and attend treatment ... caseload. Collaborates with the attending LIP, Clinical Case Manager, nurse , and other members of the treatment team, ACCESS...a case by case basis. Applies case management and utilization review principles in monitoring the delivery… more
- Trinity Health (Silver Spring, MD)
- …Type:** Full time **Shift:** **Description:** The Interim Manager of Care Management & Utilization Review , under the supervision and in collaboration with the ... Director , is responsible and accountable for the operational management,...activities of hospital staff in inpatient care coordination and utilization review . Oversees interactions of staff with… more
- Billings Clinic (Billings, MT)
- …starting. Click here (https://billingsclinic.csod.com/ats/careersite/search.aspx?site=15&c=billingsclinic) to learn more! Utilization Review RN Billings Clinic ... - 44.18 Under the direction of department leadership, the Utilization Review / Management RN. This position is...UM representatives on denials and coordinate peer to peer review with payer's medical director Initiates and… 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
- 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 quality of care and communicates findings to the director of the department. + Maintains current knowledge of...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- Hartford HealthCare (Torrington, CT)
- … Nurse Director & Social Work Supervisor, the Inpatient Psychiatric Utilization Review Social Worker will work collaboratively with the IP Psychiatry ... Patient Care Team to assure Utilization Review activities on a 17 bed Adult unit. The Care Manager will liaison with insurance companies and other referral… more
- ERP International (Nellis AFB, NV)
- …the plan and continually evaluates the impact of implementation. Incorporates applicable utilization review tasks to ensure patients receive the appropriate ... Case Management Society of America (CMSA); American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission (URAC); Comprehensive Accreditation… more
- Sharp HealthCare (San Diego, CA)
- …or case management experience + 3 Years recent case management, utilization review , care coordination experience + California Registered Nurse (RN) - CA ... position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving… more
- LA Care Health Plan (Los Angeles, CA)
- …Works with UM leadership, including the Utilization Management Medical Director , on requests where determination requires extended review . Collaborates with ... Utilization Management Admissions Liaison RN II (After Hours...specific to the case type. Identifies requests needing medical director review or input and presents for… more
- BrightSpring Health Services (Canton, OH)
- …days of death and submit to State Health Services Director and Assigned Director , Clinical Practice* Review utilization report at least monthly to ensure ... are coordinated with behavioral and programmatic staff in partnership with the Executive Director . The Director of Nursing is accountable for overseeing the… more
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