- US Tech Solutions (Canton, MA)
- …extension)** Notes: Fully remote , MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- that ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as appropriate or when ... more
- VNS Health (Manhattan, NY)
- … review of all components related to requests for services which includes a clinical record review and interviews with members, clinical staff, medical ... more
- AmeriHealth Caritas (Charleston, SC)
- …**Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for members ... more
- Elevance Health (Rancho Cordova, CA)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... more
- ManpowerGroup (Columbia, SC)
- …communicate with members and healthcare providers. **Key Responsibilities** ✔ **Medical Review & Utilization Management (80%)** + Perform medical reviews ... more
- Henry Ford Health System (Troy, MI)
- …system-wide improvements and operational processes to ensure optimal and compliant utilization review strategies. Under minimal supervision from the Manager ... more
- CommonSpirit Health Mountain Region (Centennial, CO)
- …with resources to help you flourish and leaders who care about your success. The Utilization Review RN is responsible for the review of medical records ... more
- MD Anderson Cancer Center (Houston, TX)
- …to peer or appeals to mitigate denials KEY FUNCTIONS Standards of Practice a₠" Utilization Review Concepts Applies approved clinical criteria and payer ... more
- Trinity Health (Boise, ID)
- …as well as payer specific rqeuirements + Works in coordination and collaboration with Clinical Resource Associates and Utilization Review RNs at Boise and ... more
- Fallon Health (Worcester, MA)
- …relevant clinical information from medical care providers as needed for the clinical review process + Conducts clinical reviews of retrospective and ... more
- Intermountain Health (Murray, UT)
- …regulatory requirements. + Occasional travel to provider locations within Select Health region. ** Utilization Review and Care Management:** + ** Review and ... more
- CareFirst (Washington, DC)
- …with non- clinical administrative tasks and responsibilities related to pre-service, utilization review , care coordination and quality of care. **ESSENTIAL ... more
- BayCare Health System (Clearwater, FL)
- …that's built on a foundation of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior responsibilities ... more
- Spectrum Billing Solutions (Skokie, IL)
- …is a remote or office/home hybrid position. Responsibilities include: + Review patient admission and clinical information to ensure medical necessity and ... more
- Providence (Mission Hills, CA)
- …retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all ... more
- Children's Hospital Boston (Boston, MA)
- …(Discharge Planning and or Utilization Management) preferred. Office/Site Location:BostonRegular, Temporary, Per Diem:Per Diem Remote Eligibility :Onsite Only ... more
- Elevance Health (Columbus, GA)
- …outpatient precertification, prior authorization, and post service requests. + Refers cases requiring clinical review to a Nurse reviewer . + Responsible for ... more
- CVS Health (Olympia, WA)
- …cardiology **Preferred Qualifications** -1+ years' experience in either Precertification or Utilization Review -1+ years' experience Managed Care -Strong ... more