- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …is eligible for the following personas: eWorker, mobile and resident. The Team The Clinical Utilization Reviewer is part of a highly dedicated and motivated ... your true colors to blue. The Role The Clinical Utilization Reviewer is responsible for facilitating care...: + Conduct pre-certification and concurrent and retrospective clinical review of in-state and out-of-state inpatient cases at acute… 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
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas ... help us transform healthcare? Bring your true colors to blue. The Physician Reviewer is responsible for evaluating clinical service requests made by BCBSMA members… 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
- Koniag Government Services (Germantown, MD)
- …Professional Services,** a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support **KPS** and ... with company matching, flexible spending accounts, paid holidays, three weeks paid time off, and more. Koniag Professional Services, a Koniag Government Services… more
- Elevance Health (Sacramento, CA)
- …per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process. ... **JR132259 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...for genetic tests from front-line intake. Conducting medical necessity review in adherence to guidelines and determining whether clinical… 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
- Medical Mutual of Ohio (OH)
- …as well as Medicare Advantage, Medicare Supplement, and individual plans. Manages utilization of healthcare services to ensure the provision of safe, timely, ... of services and procedures. Manages initial, concurrent, and retrospective review of cases, including appeals, through evaluation of clinical information… more
- Hartford HealthCare (Hartford, CT)
- …we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network. Hartford HealthCare Medical Group is ... and more than 30 different specialties. *_ Job Description_* The Surgical Clinical Reviewer 's (SCR) chief responsibility is to collect and submit reliable data to… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …from providers via phone and fax for the Retail Pharmacy, Medicare Advantage Part D, Home Infusion Therapy, and Medical Utilization Management benefits. ROLE ... healthcare? Bring your true colors to blue. The Clinical Pharmacist Reviewer reviews formulary exception, prior authorization and quantity limit exception requests… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE ... direction, administrative and technical supervision over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, one… 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 ... accurately; e) prepare case files for submission to Independent Review Entity, which also include writing required case summary...limited to: + Must have experience in Medicare Appeals, Utilization Case Management or Compliance in Medicare Part… more
- Prime Healthcare (Garden City, MI)
- …review /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityGarden City Hospital LocationUS-MI-Garden City ID2024-182245 CategoryAdmin Position TypeFull ... offers incredible opportunities to expand your horizons and be part of a community dedicated to making a difference....coordinates Medicaid state submission forms for presentation to on-site reviewer and files them accordingly or as per facility's… more
- State of Connecticut, Department of Administrative Services (East Hartford, CT)
- …- is accepting applications for a full- time Utilization Review ... Utilization Review Nurse Coordinator (40 Hour)...facilities for purposes of maximizing reimbursement revenue via Medicare Part B programs; + May review medical… more
- Sutter Health (Berkeley, CA)
- …and others to ensure appropriate utilization and quality care through utilization review , tracking and evaluation and objectively compare criteria with ... clinical nursing staff and other departments regarding documentation required for utilization review activities and processes. Collaborate with medical, nursing… 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
- Munson Healthcare (Traverse City, MI)
- …assessment and critical thinking skills necessary to provide utilization review responsibilities. Superior organization and time management skills required; ... trends to identify outliers who may benefit from real time coaching to improve outcomes. + Encourage healthcare team...payers and external case managers Why work as a Utilization Review Specialist at Munson Healthcare? +… 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 ID2024-172502 CategoryBusiness Professional Position TypeFull Time ShiftDays… more
- BayCare Health System (Clearwater, FL)
- …Opportunity Employer Veterans/Disabled **Position** Utilization Review Specialist Senior **Location** Clearwater | Clinical | Part Time **Req ID** null ... Health System, Utilization and Denials Mgmt-MPH **Location:** **Morton Plant** **Status:** ** Part Time , Exempt: No** **Shift Hours:** **8:00 AM - 4:30 PM**… more
- Independent Health (Buffalo, NY)
- …enjoying first-class perks, benefits and commitment to diversity and inclusion. **Overview** The Utilization Review Nurse (URN) performs clinical review to ... clinical experience as an RN in a varied clinical setting required. + Previous utilization review experience preferred. + Previous experience in a managed care… more