- Commonwealth Care Alliance (Boston, MA)
- …Group **Position Summary:** Reporting to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director ... our rapidly growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming, and excellent… more
- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) PRN position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... Recent work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare, Medicaid, and Managed Care requirements… more
- Centene Corporation (Springfield, IL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... time zone with experience in mental health settings and utilization management / review . * Department: PHCO...+ LCSW- License Clinical Social Worker required or + LMHC- Licensed Mental Health Counselor required or + LPC- Licensed… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... behavioral analytics (ABA). Additional Details: * Department: Behavioral Health Utilization Management * Business Unit: Corporate / Florida *...teams to review care services related to Applied Behavior Analysis Services… more
- Beth Israel Lahey Health (Plymouth, MA)
- …a job, you're making a difference in people's lives.** Full Time **Job Description:** ** Utilization Review & Denials management manager - Full Time** **Who We ... counties. Our Nutrition Services Team consists of registered and licensed dietitians who provide expert nutritional interventions to improve...and Serve Your Community!** **In your role as a Utilization Review & Denials Management Manager, you… more
- Children's Mercy Kansas City (Kansas City, MO)
- …within 4 years of hire + 1-2 years experience + Experience in Utilization Review + One of the following: Licensed RN - MO, Registered Nurse Multistate ... training oversight of programs and services. Responsible for effective utilization review and proper resource management of...Missouri required upon hire + One of the following: Licensed RN - Kansas, Registered Nurse Multistate License Kansas… more
- State of Indiana (Evansville, IN)
- Utilization Review Coordinator-LPN Date Posted: Aug...practice nursing in the State of Indiana as a Licensed Practical Nurse. + Must hold and maintain a ... Services certification as a Psychiatric Medicare/Medicaid Hospital. Role Overview: The Utilization Review Coordinator performs duties within a psychiatric… more
- Hackensack Meridian Health (Brick, NJ)
- …The role of **Supervisor, Care Management** integrates and coordinates utilization management, care coordination, discharge planning functions and performance ... meet staffing needs, manage length of stay, promote efficient utilization of resources and ensure that care meets evidence-based...Nurse (RN) with current New Jersey (NJ) License, or Licensed Social Worker (LSW) or Licensed Clinical… more
- Avera (Cresco, IA)
- …to join us on our mission, apply today! **Position Highlights** POSITION SUMMARY: The Utilization Review Coordinator is a member of the nursing team and ... QUALIFICATIONS: Registered Nurse from an accredited school of nursing is required. BSN preferred. Licensed for a minimum of one year as a Registered Nurse in the… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more