- Community Health Systems (Franklin, TN)
- **Job Summary** The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ... with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital utilization review … more
- Amazon (Nashville, TN)
- …to join our team! For this role, the primary function will be as a Quality Review Specialist . As an Individual Contributor, the Quality Review Specialist ... Last Mile organization. We provide these programs with operational, case management, and investigation support. Partners include but are...in the life The primary task of the Quality Specialist is to review the casework of… more
- YMCA of Greater Seattle (Seattle, WA)
- …a background check in accordance with Washington's Fair Chance Act. Please download and review the below resources for more information: ( i ) The updated 2025 ... requirements of 49.94.010: https://seattleymca.icims.com/icims2/servlet/icims2?module=AppInert&action=download&id=251099&hashed=1503034877 (ii) The WA attorney general's Washington fair chance act guide for employers and job applicants:… more
- Lilly (Indianapolis, IN)
- …determined to make life better for people around the world. **Purpose:** The Case Management Medical Review Scientist is responsible for conducting comprehensive ... medical review of Individual Case Safety Reports (ICSRs), ensuring the accuracy, integrity, and...PharmD, PhD, MSN with advanced clinical specialty (Clinical Nurse Specialist /Nurse Practitioner) with 1-3 years' experience in related scientific… more
- Trinity Health (Columbus, OH)
- …to call your own in Columbus. Learn more at www.experiencecolumbus.com ! The Peer Review Specialist provides leadership and coordination for the provider peer ... financial resources in a responsible manner. + Facilitates the provider peer review process including case identification through internal reporting data,… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible ... and advocating for appropriate levels of care. The UR Specialist works closely with clinical staff, admissions, medical providers,...+ Minimum of 2-3 years of experience in utilization review , case management, or insurance coordination in… more
- CaroMont Health (Gastonia, NC)
- …in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management, Quality and/or Case Management preferred. Minimum of ... Job Summary: Completes initial review for medical necessity for all admissions in assigned area(s), applying established criteria within 24 hours of admission.… more
- CTG (KY)
- …(remote) **Duration:** 12 months CTG is seeking a detail-oriented Disability Review Specialist to evaluate foster care case files for potential SSI childhood ... Psychology, Public Health, or related field preferred. + Experience in case review , disability evaluation, or related field preferred. Excellent verbal and… more
- HonorHealth (AZ)
- …because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of health care ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- Sanford Health (WI)
- …time **Weekly Hours:** 40.00 **Salary Range:** 31.00 - 49.50 **Job Summary** The Peer Review Specialist facilitates provider peer review processes at a ... Medical Staff peer review processes and activities to include case review , Ongoing and Focused Professional Practice Evaluation, and evaluation of provider… more