- CVS Health (Tallahassee, FL)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity for ... **Qualifications** + Outpatient behavioral health experience highly preferred + Managed care/ utilization review experience + Experience in a behavioral health… more
- CVS Health (Charleston, WV)
- …solutions to make health care more personal, convenient and affordable. This is a fully ** remote ** Utilization Review Clinical Consultant with a schedule ... needs, including some weekends **Preferred Qualifications** + Managed care experience + Utilization review experience + Ability to multitask, prioritize and… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to help us transform healthcare? Bring your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care for members ... following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part...Day : + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient… more
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Physician Clinical Reviewer - GI- REMOTE **Job Description Summary** Key member of ... utilization management team, and provides timely medical review of service requests that do not initially meet...clinical determinations cannot be made by the Initial Clinical Reviewer . + Discusses determinations with requesting… more
- Magellan Health Services (Baton Rouge, LA)
- … management according to medical necessity criteria. General Job Information Title Clinical Reviewer III (Baton Rouge, LA or Remote in LA) Grade 26 Work ... staff. + Provides training, interpretation and support for QI Clinical Reviewer staff. + Audits and validates...Experience - Required Clinical , Utilization Management Work Experience - Preferred… more
- CVS Health (Oklahoma City, OK)
- …affordable. **Position Summary** _Must reside in state of Oklahoma, position is 100% remote ._ ABA Utilization Management Clinical Consultant applies critical ... Experience working in the Oklahoma Medicaid Health system + Managed care experience + Utilization review experience + Claims review experience strongly +… more
- Kepro (AR)
- …workload management experience. + Experience with State Medicaid Dental programs. + Utilization Management/ Clinical Review experience. #LI-SD1 Why us? We ... public sector. Acentra is looking for a Supervisor, Dental Review ( Remote within Arkansas) to join our...Clinical Director and Medical Director, the Supervisor, Dental Review oversees dental staff performing Utilization Management… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA. The ... healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service...anticipatory case management for members whose cases come for review , in partnership with case managers + Participate in… more
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... **Job Title: Medical Claims Reviewer ** **Pay Rate:23/Hr ( REMOTE opportunity after...services. + Ensure thorough documentation of each determination for utilization or claims review . + Review… more
- Medical Mutual of Ohio (OH)
- …work at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Responsibilities** + ... preferred. + 3 years as a Registered Nurse with a combination of clinical and or utilization /case management experience, preferably in the health insurance… more
- Medical Mutual of Ohio (OH)
- … review of cases, including appeals, through evaluation of clinical information using established national decision support criteria, Company policies, individual ... **_Note,_** **_this is a fully remote opportunity in Ohio_** . Founded in 1934,...years as a Registered Nurse with a combination of clinical and utilization /case management experience in pharmacy,… more
- Centene Corporation (Olympia, WA)
- …the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, ... benefits including a fresh perspective on workplace flexibility. POSITION IS REMOTE **Position Purpose:** Authorize, direct and monitor care for behavioral health… more
- Magellan Health Services (Boise, ID)
- …that directly influence quality of care. General Job Information Title Care Manager (SUD utilization review preferred) - REMOTE USA Grade 24 Work Experience ... live in Idaho. Also interested in candidates with SUD utilization review experience. Under general supervision, and...supervision, and in collaboration with other members of the clinical team, authorizes and reviews utilization of… more
- VNS Health (Manhattan, NY)
- …- $130,800.00 Annual * Reviews specific utilization issues or requests with Clinical Review team, focusing on problem solving, response to actual or ... settings. * Manages and evaluates staff in delivery and coordination of utilization management review services in compliance with CMS guidelines and… more
- Sharp HealthCare (San Diego, CA)
- …Professional (AHA BLS Healthcare) - American Heart Association; California BBS Licensed Clinical Social Worker (LCSW) - CA Board of Behavioral Sciences; California ... 8/40 - 8 Hour Shift **Additional Shift Information:** *Flex start time / Remote work is not available **Weekend Requirements:** No Weekends **On-Call Required:** No… 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 ... team, or care manager generated requests for medical services and renders clinical determinations in accordance with healthcare policies as well as applicable state… more
- CareFirst (Baltimore, MD)
- …coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts, ... **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective,… more
- Community Health Network (Indianapolis, IN)
- …Nursing Job Family Remote / Work from Home / Virtual Department Utilization Review Schedule Full-time Facility Castleway / Castleton Office Park Castleway ... Utilization Review Registered Nurse (RN) Job... clinical experience or three years recent hospital utilization review /case management experience. (Required) **Why Community?**… more
- Elevance Health (Norfolk, VA)
- …Requirements:** + Requires a HS diploma or equivalent and a minimum of 2 years of clinical or utilization review experience and minimum of 1 year of managed ... **Title:** Licensed Utilization Review II **Location** : This position will work a remote model, but candidates must live within 50 miles of one of our… more
- Centene Corporation (Springfield, IL)
- …OVERTIME IS OFFERED ON A VOLUNTARY BASIS AS NEEDED.** **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance ... and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and… more