- Kelsey-Seybold Clinic (Pearland, TX)
- **Responsibilities** The Utilization Review Specialist ( LVN ) is responsible for conducting medical reviews, benefit verification, and applying criteria ... care services requiring authorization prior to services being rendered for members. The Utilization Review Specialist ( LVN ) serves as a liaison in… more
- LA Care Health Plan (Los Angeles, CA)
- Utilization Management Nurse Specialist LVN II Job Category: Clinical Department: Utilization Management Location: Los Angeles, CA, US, 90017 Position ... to support the safety net required to achieve that purpose. Job Summary The Utilization Management Nurse Specialist LVN II will facilitate, coordinate and… more
- STG International (Milledgeville, GA)
- …our Georgia Ware Veterans Home. JOB SUMMARY: The primary purpose of the lead LPN/ LVN is to provide direct nursing care to the residents. ESSENTIAL FUNCTIONS: + ... forms, reports, evaluations, studies, charting, etc., as necessary. + Periodically review the department's policies and procedures manuals, job descriptions, etc.,… more
- The Cigna Group (Harlingen, TX)
- …skills * Typing and computer knowledge- able to type 35WPM * Knowledge of utilization review requirements and procedures * Knowledge of current health care ... up calls which may include primary care physician and specialist appointment scheduling * Collaborates with the attending physician...Duties as assigned. **Experience:** * Current Licensure as a LPN/ LVN or RN, in the state of Texas in… more
- Amergis (Orange, CA)
- The LPN/ LVN Case Manager is responsible for coordinatingcontinuum of care activities for assigned patients and ensuring optimumutilization of resources, service ... + Documents patient case information within a database system + Performs chart review /audits monthly or as needed + Participates in monthly case conferences by… more
- Integra Partners (Troy, MI)
- …do whatever it takes to get things done. PREFERRED SKILLS: + Certification in Utilization Review or Case Management + Experience with health insurance operations ... our Operations Training & Development team as an Operations UM Training Specialist , specializing in Utilization Management (UM) processes. The ideal candidate… more
- LA Care Health Plan (Los Angeles, CA)
- …patient care, such as ambulatory care, home care, or case management. OR experience in Utilization Review or Care Management will be considered in lieu of direct ... and/or disabilities in a case/care management environment. Preferred: Experience in utilization review , skilled nursing, home health, discharge planning,… more
- Abbott (Plano, TX)
- …required clinical information for authorizations. + Work with respective carrier's utilization review department to obtain appropriate authorizations. + Assist ... Worker's Compensation and Medicare guidelines pertaining to Prospective and Retrospective Utilization Review . + Proficient with Microsoft Office (Word &… more
- Select Medical (Lakeway, TX)
- …licenses, if candidate also has extensive experience with prior authorizations and/or utilization review + Previous Experience within a physical rehabilitation ... Medical & Baylor Scott & White Health **Prior Authorization Specialist -** **onsite only** **This position must work** **onsite**...**Minimum Qualifications** + Licensure as a Registered Nurse or LVN /LPN is required + 2 years of of direct… more
- Guardian Life (Bethlehem, PA)
- Guardian has an opportunity in the role of **Medical Specialist ** where you will be knowledgeable in a variety of medical and behavioral health conditions. This ... individual may also be required to help with coordinating and overseeing vendor utilization and assist in determining overall function as needed to facilitate timely… more
- Banner Health (Mesa, AZ)
- …management process. Reviews audit results and presents summary information for management utilization and review . 7. May coordinate the admission process ... at other agencies - a field preceptor, an IT specialist , a dedicated scheduler, a nurse preceptor during orientation...MINIMUM QUALIFICATIONS Must possess a current, valid LPN or LVN license in state of practice, temporary LPN or… more
- ManpowerGroup (Columbia, SC)
- …of medical claims review processes, medical necessity guidelines, and utilization review practices. + Proficiency in medical terminology, coding procedures, ... state of hire. **Job Description:** As a Medical Claims Reviewer/ Utilization Management Specialist , you will be responsible...services. + Ensure thorough documentation of each determination for utilization or claims review . + Review… more