- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …(Inpatient, outpatient, or differing levels of care). + Utilization Management experience, preferred + Experience with Medicare Advantage, preferred + ... help us transform healthcare? Bring your true colors to blue. The RoleThe Clinical Utilization Reviewer is responsible for facilitating care for our Medicare … more
- UCLA Health (Los Angeles, CA)
- …level. You can do all this and more at UCLA Health. As a Manager for Medicare Advantage Utilization Management , you'll provide direct management to a ... of UM coordinators and nurses. You'll work closely with Medicare Advantage leadership to plan, execute, and manage various...HMO environment + Thorough knowledge of health care industry, utilization review , utilization management… more
- Dignity Health (Rancho Cordova, CA)
- …skills: + Comprehensive knowledge of utilization management + Medicare , Medicaid, and commercial admission and review requirements + In-depth knowledge ... You can also follow us on Twitter and Facebook. **Responsibilities** The Utilization Management (UM) Manager is responsible for managing day-to-day UM… more
- Medical Mutual of Ohio (OH)
- …to work at home. We are looking for applicants that have a strong clinical utilization management background. Medicare experience is a plus. **Founded in ... care at the most appropriate time + Keeps up to date on utilization management regulations, policies, and practices, including applicable coding + Performs… more
- Evolent (Columbus, OH)
- …clinical objectives **Desired Skill Set** + Understanding of regulatory framework for utilization management in Medicare , Medicaid, and Commercial contexts ... of physician, nursing, and shared services staff in the utilization management value chain + Owns clinical...and implementation of new strategies to make the clinical review process more efficient through people, processes, and technology… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment (as a clinician or in ... of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical...to evaluate clinical service requests + Practice anticipatory case management for members whose cases come for review… more
- Evolent (Columbus, OH)
- …Doing:** As a Physician Clinical Reviewer you will be a key member of the utilization management team. We can offer you a meaningful way to make a difference ... utilization and compliance with SBU`s policies/procedures, as well as Utilization Review Accreditation Commission (URAC) and National Committee for Quality… more
- Elevance Health (Miami, FL)
- …in an ambulatory or hospital setting or minimum of 1 year of prior utilization management , medical management and/or quality management , and/or ... applicable state(s) required. **Preferred Skills, Capabilities & Experiences:** Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...to enroll eligible individuals who are either Medicaid or Medicaid/ Medicare recipients and optimize their ability to remain in… more
- Chenega Corporation (NM)
- …reporting, analysis, and makes recommendations for improvement. + Refers cases for review as appropriate to Program Integrity, Case Management , Care ... Services** ' company, is looking for a fully remote **Clinical Quality Reviewer ** to ensure compliance with the contract, and program requirements for Clinical… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Mohawk Valley Health System (Utica, NY)
- RN - Utilization Review Nurse - Full Time...CASE MANAGEMENT Job Summary The RN - Utilization Management gathers clinical information to determine ... advisors as needed to appeal concurrent UR denials. + Complete daily utilization review of all observation/outpatient/in-bed patients. Collaborate with Care… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management , and transitions of ... on length of stay, level of care requirements and Medicare regulations, and Major Complications or Comorbidities (MCC) /...ie MCG, Xsolis) b. Supports & Participates in pre-admission review , utilization management , and concurrent… more
- Hackensack Meridian Health (Hackensack, NJ)
- …Hackensack UMC. These include but are not limited to utilization review ,** **hospital reimbursement, clinical compliance, case management , and transitions of ... Criteria ( ie MCG,** **Xsolis)** **b. Supports & Participates in pre-admission review , utilization management , and concurrent and** **retrospective … more
- Behavioral Center of Michigan (Warren, MI)
- Under general supervision, the Utilization Review Coordinator provides professional assessment, planning, coordination, implementation and reporting of complex ... clinical data and supports the operations of Samaritan Behavioral Center. The Utilization Review Coordinator reviews the patient's chart and records clinical… more
- CareFirst (Baltimore, MD)
- …in a clinical and utilization review role. 3 years Management experience. **Preferred Qualifications:** + Knowledge of Medicare Advantage + Knowledge of ... based on business needs and work activities/deliverables that week. The Director, Utilization Management provides strategic leadership of the utilization … more
- Stanford Health Care (Palo Alto, CA)
- …Skills and Abilities** + Knowledge of principles and best practices of case management , utilization review , social work, care coordination and discharge ... practice. Here, your leadership, coaching, and mentoring would further develop our robust, Utilization Management team. Are you driven by health care innovation,… more
- US Tech Solutions (Chicago, IL)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE...with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an… more
- US Tech Solutions (May, OK)
- …MANAGED CARE exp and Medicare /Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF ... policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. ....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. . MUST HAVE… more
- HonorHealth (Scottsdale, AZ)
- …communities across Arizona. Learn more at HonorHealth.com. Responsibilities Job Summary The Utilization Review RN Specialist reviews and monitors utilization ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more