- nTech Solutions, Inc. (Baltimore, MD)
- …assisting with non- clinical administrative tasks and responsibilities related to pre-service, utilization review , care coordination and quality of care. The ... of Employment W2, 3 Months This position is 100% remote . With that said, candidates must reside in Maryland,...Management Coordinators will receive cases from the Manager of Clinical Support on a daily basis, review … more
- Aequor (New York, NY)
- …York State Prefer minimum of 1-3 years relevant experience in case management, utilization review and/or quality assurance Experience in acute episodic care, ... Position Purpose:Provide case management and clinical services to employees within their regulated scope...days onsite, then 4 days/week onsite and 1 day remote ) 8:30 AM to 4:30 PM (Monday - Friday)… more
- Blanchard Valley Hospital (Findlay, OH)
- …compliant and optimal professional charge capture which is supported by clinical documentation. Coordinate with the Professional Coding Integrity Auditor/Educator to ... and collaboration between all members of the team, including onsite and remote associates. Duty 2: Perform supervisory administrative support functions including but… more
- Northeast Georgia Health System, Inc (Gainesville, GA)
- …of individual patient needs; Works collaborate with the Physicians, patient/family, nursing, utilization review and other members of the healthcare team to ... aligns with patient needs using resources to meet quality, clinical and cost effective outcomes. Coordinates a team approach...to ensure services will be covered.Coordinate and communicate with Utilization Review Nurse on a daily, consistent… more
- Saint Francis Health System (Tulsa, OK)
- …Time7p - 7aVirtual Nurse works from an on-site office location (not a remote position)Will perform admit, discharge chart review and other patient care ... knowledge of general disease state management processes, bio-psychosocial model, and clinical pathways. Ability to receive and understand information relayed through… more
- Kepro (Los Angeles, CA)
- …to being a vital partner for health solutions in the public sector. Acentra seeks a Utilization Clinical Reviewer to join our growing team. Job Summary As a ... Utilization Clinical Reviewer , you'll harness...the accuracy and consistency of the Psychiatric Inpatient Concurrent Review process in alignment with the esteemed California Mental… more
- Kepro (Minneapolis, MN)
- …the public sector. Acentra is looking for a Utilization Management - Mental Health Clinical Reviewer to join our growing team. This is a Remote position ... Job Summary: The purpose of this position is to utilize clinical expertise to review medical records against appropriate criteria in conjunction with contract… more
- Kepro (Los Angeles, CA)
- …for health solutions in the public sector. Position Overview: As a Utilization Reviewer , you involves reviewing medical records against appropriate criteria ... Health exists to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions that deliver… 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
- Prime Therapeutics (Columbus, OH)
- …fuels our passion and drives every decision we make. **Job Posting Title** Clinical Pharmacist Reviewer - REMOTE **Job Description Summary** Facilitates ... efforts in the development of medical pharmacy solutions programs. Supports drug utilization review (DUR) efforts by reviewing physician prescribing patterns,… more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...Acentra seeks an Internal Medicine or Family Practice Physician Reviewer (Illinois Remote , PRN) to join our… more
- Kepro (Lombard, IL)
- …leadership and clinical expertise to operations relating to the peer review process, utilization review activities, and other activities requiring ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...in the public sector. Acentra seeks an OBGYN Physician Reviewer (PRN, Remote within Illinois) to join… more
- Kepro (AL)
- …the Alabama Utilization Management contract. The Physical Therapist will utilize clinical expertise for the review of medical records against appropriate ... to empower better health outcomes through technology, services, and clinical expertise. Our mission is to innovate health solutions...public sector. Acentra is looking for a Physical Therapist Reviewer ( Remote ) join our growing team. Are… more
- Centene Corporation (Springfield, IL)
- …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, ... competitive benefits including a fresh perspective on workplace flexibility. Position is REMOTE PREFERRED CANDIDATE WILL BE LICENSED PSYCHOLOGIST IN THE STATE OF… more
- Providence (WA)
- …best people, we must empower them._** **Providence Health Plan is calling an Associate Utilization Review Specialist who will:** + Be responsible for all core ... functions in one or more of the following clinical teams: + Prior-authorization (PA) + Concurrent Review...call centers, research briefs, provider resolutions) **Providence welcome 100% remote work for residents who reside in the following… more
- Henry Ford Health System (Troy, MI)
- …SUMMARY: The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution ... This position is REMOTE 8 hour shifts between 7:30am and 6:00pm...and various revenue cycle related requirements. * Submits all clinical information required by payers. * Responds to payer… more
- Actalent (Kansas City, KS)
- Job Title: Utilization Review - Post Acute Care Job Description Our PAC Nurse is a telephonic role responsible for recommending discharge plans, assisting with ... plans. The PAC Nurse will also act as a clinical resource for unlicensed Post-Acute Care Coordinators and will...care management + Length of stay management + Concurrent Review Job Type This is a Contract-to-Hire position with… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- Perform comprehensive clinical review of requested services utilizing clinical criteria, received through various mechanisms **Job Description:** **Job ... the Medical Director when appropriate, according to policy\. + Assists non\- clinical staff in performance of administrative reviews + Performing comprehensive… more
- Centene Corporation (Austin, TX)
- …insight and guidance on the review of member medical records to the utilization review BH team + Provides guidance and expert knowledge as appropriate to ... the behavioral health utilization review team members to ensure the...Master's degree for behavioral health clinicians required. Highly advanced clinical knowledge and ability to review and/or… more
- Commonwealth Care Alliance (Boston, MA)
- …case review , workflow review and other relevant business related to utilization review process. + Works in collaboration with the UM Manager to promote ... authorization request process to ensure regulatory compliant outcomes. + Interface with clinical team for interpretation of clinical criteria, escalation and… more
