- Kepro (CA)
- …a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team in California. Job Summary ... As a Utilization Clinical Reviewer , you'll harness your expertise...play a pivotal role in upholding industry benchmarks. This full- time Clinical Reviewer Remote position based in… more
- Guthrie (Binghamton, NY)
- …- Utilization Management (Days) Full Time Position Summary: The Utilization Management (UM) Reviewer , in collaboration with other internal and external ... for prior authorization/certification for reimbursement of patient care services. The Utilization Reviewer : * Secures authorization as appropriate * Documents… more
- Point32Health (MA)
- …Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Provide behavioral health utilization review and care management in order to ensure ... plans of treatment. Work as a member of one of the Concurrent Review Team. **Key** **Responsibilities/Duties** **- what you will be doing** Coordinate the delivery… more
- Point32Health (MA)
- …here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Behavioral Health Psychologist Reviewer will primarily perform utilization management and provider ... utmost importance. **Key** **Responsibilities/Duties** **- what you will be doing** ** Utilization Management** + Performs clinical review of prospective,… more
- Point32Health (MA)
- …disposition of coverage decisions as required by product specific compliance and regulatory time frames. The Clinical Reviewer functions as a member of the ... are at Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** The Clinical Reviewer is a licensed Registered Nurse that is expected to function… more
- Prime Therapeutics (Columbus, OH)
- … Reviewer - GI- REMOTE **Job Description Summary** Key member of the utilization management team, and provides timely medical review of service requests ... medical/clinical review guidelines and parameters to assure consistency in the MD review process so as to reflect appropriate utilization and compliance with… more
- Brighton Health Plan Solutions, LLC (New York, NY)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Group Health and Workers' Compensation ... coordinate medical and disability services for timely return to work. + Provides utilization review , continued stay reviews, and utilization management based… more
- Elevance Health (Topeka, KS)
- **Please note: This is a part time (20 hours/week) role where the successful hire will be licensed and domiciled in the state of Kansas and will be within 50 ... per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.… more
- Trinity Health (Livonia, MI)
- **Employment Type:** Part time **Shift:** Rotating Shift **Description:** **JOB SUMMARY** The Clinical Nurse Reviewer 's chief responsibility is to collect ... database of all eligible cases for the hospital. The Clinical Nurse Reviewer also works closely with the physician champion and appropriate hospital leadership… more
- US Tech Solutions (Columbia, SC)
- …PREFERRED/NICE TO HAVE skill sets/qualities: I would love to have someone with prior insurance/ utilization review experience, but I know that is not very common. ... standards set for our area. New nurses are given time to work up to this, but should be...any of the following in support of medical claims review and utilization review practices:… more
- AdventHealth (Bolingbrook, IL)
- …**Category:** Patient Experience **Organization:** UChicago Medicine AdventHealth Bolingbrook **Schedule:** Part - time **Shift:** 1 - Day **Req ID:** 24031491 ... annual thereafter) follow-up data components for the program through the effective utilization of the hospital medical record systems and through a coordinated… more
- The Cigna Group (Bloomfield, CT)
- **Cigna Medicare Part C Appeals Reviewer : Appeals Processing Analyst** We will depend on you to communicate some of our most critical information to the correct ... Requirements include, but not limited to:** + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part C + Ability to… more
- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist (LVN) serves as a liaison in reviewing… more
- HCA Healthcare (Nashville, TN)
- …want with your current employer? We have an exciting opportunity for you to join our Utilization Review team which is part of the nation's leading provider ... Health Assistance Fund that offers free employee-only coverage to full- time and part - time colleagues based...of colleagues. Do you want to work as a(an) Utilization Review Nurse BH WFH where your… 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
- Prime Healthcare (Ontario, CA)
- …Utilization review tech essentially works to coordinate the utilization review and appeals process as part of the denial management initiatives. This ... utilization - review -technician-iii/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityPrime Healthcare Management Inc LocationUS-CA-Ontario ID2024-172509 CategoryBusiness Professional Position TypeFull Time ShiftDays… more
- BayCare Health System (Cotton Plant, AR)
- …Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant** **Status:** ** Part Time , Exempt: No** **Shift Hours:** **8:00 AM - 4:30 PM** ... clinical excellence. **BayCare Health System** is currently seeking a ** Utilization Review Specialist Senior** to join our... Review Specialist Senior **Location** Clearwater:Morton Plant | Clinical | Part Time **Req ID**… more
- Elevance Health (Tampa, FL)
- …Elevance Health PulsePoint locations. **Hours** **: Monday through Friday,10:30 - 7:00 Eastern time ** The **Licensed Utilization Review II** responsible for ... **Licensed Utilization Review II** **Location** : KS,...**Licensed Utilization Review II** **Location** : KS, FL. and VA....several times per week. Specific requirements and expectations for time onsite will be discussed as part … more
- Emory Healthcare/Emory University (Atlanta, GA)
- …programs + And more **Description** We're seeking an **Assistant Manager, Utilization Review ** , responsible for supervising and coordinating activities ... of personnel in the Utilization Review Department, including: + Staff schedules...Demonstrates leadership abilities. JOIN OUR TEAM TODAY!Emory Healthcare (EHC), part of Emory University (EUV), is the most comprehensive… more
- Independent Health (Buffalo, NY)
- …first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse performs clinical reviews to determine the ... of clinical experience in acute hospital care and/or three (3) years of utilization review experience required. + Previous experience in managed care preferred.… more