- Merck & Co. (North Wales, PA)
- …Laboratories drive break-through science through drug discovery, development, and clinical evaluation to address the significant unmet medical needs.-Finance is ... a trusted business partner, playing a critical role in ensuring effective resource utilization to achieve this mission. This is a unique opportunity to gain exposure… more
- CVS Health (Trenton, NJ)
- …more personal, convenient and affordable. **Position Summary** This is a fulltime remote Utilization Management Clinical Consultant opportunity. Schedule is ... occasional rotating weekend and holiday schedules **Preferred** **Qualifications** + Managed care/ utilization review experience + Experience in a behavioral… 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
- 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
- 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
- Kepro (AR)
- …health solutions in the public sector. Acentra is looking for a Clinical Reviewer - Behavioral Health - PRN ( Remote within Arkansas) ** The selected ... availability can vary. ** ** This is a fully remote position where you must reside and work in... of clinical records. Preferred Qualifications/Experience: + Utilization Review / Utilization Management experience. +… more
- El Paso County (Colorado Springs, CO)
- Utilization Reviewer - Behavioral Health Print (https://www.governmentjobs.com/careers/elpasocountyco/jobs/newprint/4719458) Apply Utilization Reviewer ... - $107,180.00 Annually Location Colorado Springs, CO Job Type Full-Time Remote Employment Flexible/Hybrid Job Number 2400590 Department Department of Human Services… 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
- 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
- Elevance Health (Sacramento, CA)
- …or requires physician review or override. + Clearly and concisely documenting clinical review and other case interactions in online database in adherence to ... **JR132259 Genetic Counselor Reviewer ** The genetic counselor reviewer (GCR)...for authorization requests and determining their appropriateness per designated clinical guidelines, clinical policies, and client rules.… more
- Banner Health (AZ)
- …on your experience as a Registered Nurse and your knowledge of Case Managment and Utilization Management to review clinical records to ensure patients are in ... or other staff of non-company locations on concurrent and retrospective utilization review . Accurately and thoroughly completes documentation required for… 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
- 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
- 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
- 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
- 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
