- Dignity Health (Gilbert, AZ)
- **Job Summary and Responsibilities** Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective ... utilization review to support and encourage the efficient and...admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is… more
- AmeriHealth Caritas (Washington, DC)
- **$5,000.00 SIGN ON BONUS** **Role Overview** Our Utilization Management Reviewers evaluate medical necessity for inpatient and outpatient services, ensuring ... with medical policies. When necessary, cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral… more
- Guthrie (Cortland, NY)
- Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other physician offices, and the Robert Packer ... Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior authorization/certification for… more
- Saint Francis Health System (Tulsa, OK)
- …in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of internal ... individual patient situations, reporting them promptly to the Process Improvement/Quality Director , to appropriate clinicians and to the UM Manager. Reviews… more
- South Middlesex Opportunity Council (Framingham, MA)
- …children and families. This position will coordinate billing and monitor utilization review for the Clinic and Residential Recovery Programs. Candidates must ... priorities and meet deadlines Organizational Relationship: Directly reports to Operations Director . Indirectly reports to Director of Residential Recovery… more
- AmeriHealth Caritas (LA)
- …Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical necessity ... to authorize services and appropriately identify and refer requests to the Medical Director when indicated. The BH UM Reviewers are responsible to ensure that… more
- Integra Partners (Troy, MI)
- …experienced in the managed care payor environment to perform pre-service and post-service utilization reviews and appeals for DMEPOS. This individual will play a key ... role in collaborating with our Medical Director to perform benefit and medical necessity reviews and...medical necessity criteria + Refer cases to the Medical Director that do not meet medical necessity criteria +… more
- CVS Health (Columbus, OH)
- …difference in the lives of patients facing complex medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review, you'll play a ... nurses use specific criteria to authorize procedures/services or initiate a Medical Director referral as needed. + Assists management with training new nurse… more
- Centene Corporation (New York, NY)
- …and a NYS Driver's License or Identification card.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all outpatient ... determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and… more
- Integra Partners (Troy, MI)
- …UM Coordinator assists and supports the clinical team (UM Nurses/Medical Director ) with administrative and non-clinical tasks related to processing Utilization ... and other internal & external sources + Other duties as assigned by UM Director + Strong organizational skills, ability to adapt quickly to change and desire to… more