- Emanate Health (Covina, CA)
- …two (2) years of recent acute clinical experience and/or two years in Case Management, Utilization Review , payer appeals or related programs required. Experience ... company in the country. **J** **ob Summary** The Manager, Medical Necessity Review & Appeals is responsible for overseeing the evaluation of medical necessity,… more
- Emanate Health (Covina, CA)
- …requested services using clinical judgment and refer to Medical Directors for review depending on case findings. **Job Requirements** **M** **inimum Education ... the #19 ranked company in the country. **J** **ob Summary** The Utilization Review Nurse will evaluate medical records to determine medical necessity by applying… more
- KeyBank (Lea County, NM)
- …Ohio 44144 **About the Job** The Senior Compliance Officer - Special Projects Review Team (SPRT) role reports to KeyBank's Financial Crimes Risk Management's (FCRM) ... (CAMLO) / FCRM Leadership, Key Executive Leadership, Key Legal, or Key Risk Review Group (Audit). This role requires excellent people / communication / listening… more
- Hackensack Meridian Health (Hackensack, NJ)
- …University Medical Center. These include but are not limited to utilization review , hospital reimbursement, clinical compliance, case management, and transitions ... The Utilization Review Physician collaborates with the healthcare team in...Certification. 2. At least two years experience in Utilization Review processes including knowledge of regulatory requirements relative to… more
- State of Montana (Helena, MT)
- …our Forms Bureau. The successful candidate will serve as a contract reviewer , responsible for thoroughly analyzing and reviewing complex insurance contracts, policy ... following essential functions and other similar tasks: * *Insurance Contract and Form Review :* Review and analyze insurance policy forms and contracts to ensure… more
- US Tech Solutions (Columbia, SC)
- …promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and ... and contract benefits. + Utilizes allocated resources to back up review determinations. Identifies and makes referrals to appropriate staff (Medical Director,… more
- Sutter Health (Sacramento, CA)
- …negotiation skills. + A broad knowledge base of health care delivery and case management within a managed care environment. + Comprehensive knowledge of Utilization ... Review , levels of care, and observation status. + Some awareness of healthcare reimbursement systems: Health Maintenance Organization (HMO), Preferred Provider… more
- Army National Guard Units (Phoenix, AZ)
- …or assignment; removal of military member from active or inactive status). Performs complete review of records and other case documentation to ensure that they ... of this position is to serve as the final reviewer and procedural authority of personnel actions submitted to...that all levels of legal, medical, pay and administrative review have been completed. Cases have major effects on… more
- Army National Guard Units (Columbus, OH)
- …or assignment; removal of military member from active or inactive status). Performs complete review of records and other case documentation to ensure that they ... of this position is to serve as the final reviewer and procedural authority of personnel actions submitted to...that all levels of legal, medical, pay and administrative review have been completed. Cases have major effects on… more
- The Cigna Group (Bloomfield, CT)
- …Cigna. **Summary description of position** : A Medical Principal performs medical review and case management activities. The physician provides clinical insight ... CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed care setting. +… more