- CVS Health (Charleston, WV)
- …to make health care more personal, convenient and affordable. This is a fully ** remote ** Utilization Review Clinical Consultant with a schedule of ... needs, including some weekends **Preferred Qualifications** + Managed care experience + Utilization review experience + Ability to multitask, prioritize and… more
- Actalent (Atlanta, GA)
- Actalent is currently hiring for Remote Utilization Review RNs! Job Description: + Reviewing authorization requests + Utilizing evidence-based criteria and ... additional details if applicable. Qualifications: + Active RN License + Prior Utilization management/Concurrent review experience + Experience with MCG Why… more
- 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. ... information to payers as needed. * Maintain a current knowledge of Utilization Management through interaction with staff and payor portal representatives. * Identify… more
- LifePoint Health (Henderson, NC)
- …to work with minimal supervision. **Job:** **Nursing* **Organization:** ** **Title:** * Utilization Review RN Temp ( Remote )* **Location:** *NC-Henderson* ... *Monitors adherence to the hospital's utilization review plan to ensure appropriate use of hospital services, hospital admissions and extended hospitals stays. *… more
- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- POSITION TITLE: Utilization Review Clinician REPORTS TO (TITLE): Director of Utilization Review DESCRIPTION OF POSITION: Work as member of ... to third party payers. + Recordkeeping: Maintains appropriate records of the Utilization Review Department. + Training: Provide staff in-service training and… more
- 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 ... * Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with CMS guidelines and consistent with… more
- 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
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Utilization review ... tech essentially works to coordinate the utilization review and appeals process as part of the denial...an SME to support the UR tech team and remote counter parts with the specific processes as applicable.… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- R1 RCM (Salt Lake City, UT)
- …encompassing sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Utilization Review Author** , you will help our hospital ... basic computer skills is essential for excelling in this remote position. **Here's what you will experience working as...position. **Here's what you will experience working as a Utilization Review Author:** + Perform initial admission… more
- Centene Corporation (Jefferson City, MO)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE WORK HOURS FOR FIRST 90 DAYS WILL BE...SATURDAY POTENTIAL FOR HOLIDAYS **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- 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 ... weekdays and 1 weekend day as discussed with manager. The **Licensed Utilization Review II** is responsible for working primarily with healthcare providers to… more
- Providence (Kodiak, AK)
- …for discharge planning, admission to swing bed and case management including utilization review in accordance with Providence philosophy, objectives, policies, ... and standards. The Case Manager/RN Navigator partners with the Utilization Review nurse, patients, physicians, and interdisciplinary...we must empower them. **This position can be a Remote work opportunity, if you reside within the State… more
- Providence (Mission Hills, CA)
- …Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St ... **Description** Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records… more
- 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...Biweekly Location Lansing, MI Job Type Permanent Full Time Remote Employment Remote Only Job Number 3901-25-BPHASA-MCM-012-FILL… more
- Stanford Health Care (Palo Alto, CA)
- …records to ensure the necessity and appropriateness of care provided. 3. Utilization Review : Conduct thorough utilization reviews, applying evidence-based ... the Emergency Department. This position changed from onsite to remote . This is not a CRONA-union position. This role...utilization management principles. + Experience in case management, utilization review , or related healthcare roles. +… more
- Centene Corporation (Madison, WI)
- …related to member care, provider interactions, and facilitates operations within utilization management. + Manages prior authorization, concurrent review , and ... perspective on workplace flexibility. **Position Purpose:** Manages Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- Sharp HealthCare (San Diego, CA)
- …8/40 - 8 Hour Shift **Additional Shift Information:** *Flex start time / Remote work is not available **Weekend Requirements:** No Weekends **On-Call Required:** No ... employer business practices. **What You Will Do** Perform admission and concurrent review of patients, based upon needs regardless of payor sources. Identifies… more
- Hackensack Meridian Health (Neptune, NJ)
- …**Hackensack Meridian** **_Health_** includes: + Follows departmental workflows for utilization review activities including admission reviews, admission denials, ... leader of positive change. The **Care Management, Care Coordinator, Utilization Management** is a member of the healthcare team...New Jersey regulations for Nursing **.** **This is a remote , night shift position. The schedule for this role… more
- CVS Health (Phoenix, AZ)
- …care experience is in behavioral health) **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 100% ...Utilization Management (UM) Nurse Consultant role is 100% remote and the candidate can live in any state.… more