- Brighton Health Plan Solutions, LLC (NC)
- …experience in a UM team within managed care setting. * 3+ years' experience in clinical nurse setting preferred. * TPA Experience preferred. Powered by JazzHR ... BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in… more
- HCA Healthcare (Las Vegas, NV)
- …as we do. We want you to apply! **Job Summary and Qualifications** The IPAT Clinical Analyst NICU- (Code Pink) will review post discharge, prebill accounts that ... + Healthcare experience in an acute care hospital. Utilization Review , appeals , denials, managed care contracting, experienced...compelling, we encourage you to apply for our IPAT Clinical Analyst opening. We promptly review all… more
- Intermountain Health (Billings, MT)
- …supplies, and resources. + **Evaluate:** Evaluates patient response to interventions through review of achievement of goals, clinical outcomes, patient, and ... **Job Description:** The Registered Nurse (RN) is a professional caregiver who assumes...Billings has a one-of-a-kind lifestyle with work balance that appeals to many. Check out these videos to hear… more
- Dana-Farber Cancer Institute (Brookline, MA)
- …high volume, dynamic environment, the Clinical Authorization Specialist will bring clinical expertise to the prior authorization and appeals processes and ... clinical and/or related experience required. Case Management, Utilization Review and/or Prior Authorization experience is preferred. + **Certification/Licensure/Registration:**… more
- Beth Israel Lahey Health (Plymouth, MA)
- …data to establish the appropriate level of care using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal ... team to assess and improve the denial management, documentation, and appeals process. + Collaborates with UR Manager and/or physician advisor regarding… more
- 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 ... collaborates with healthcare providers to facilitate efficient patient care. The Clinical Utilization Review Specialist monitors adherence to hospital… more
- Nuvance Health (Danbury, CT)
- …oversight for a team of utilization review staff, denials and appeals specialists, non- clinical support staff while partnering with local case management ... will be responsible for leading a team encompassing utilization review and denials/ appeals specialists and will need...nurse (RN) * Minimum of 5 years of clinical experience in an acute care setting * Minimum… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …oversees all Clinical Services (CS) functions (prior authorization, concurrent review , appeals , case management, disease management, population health) per ... a full-service health plan administrator is looking for a full-time dynamic clinical leader who will provide leadership, oversight and accountability for our … more
- Providence (OR)
- …Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical Audits, Appeals or Delegation) + ... best people, we must empower them.** **Providence Health Plan is calling a Clinical Program Coordinator RN, Medicare / Medicaid who will:** + Provide care… more
- Veterans Affairs, Veterans Health Administration (Eagan, MN)
- …program eligibility, service delivery, location, level of care discharge planning, appeals process, and performance improvement. Conducts comprehensive clinical ... team (IDT) responsible for providing centralized, standardized, administrative and clinical eligibility reviews for authorization of purchased in home services.… more