• Utilization Management Nurse Consultant…

    CVS Health (Columbus, OH)
    medical journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ensuring members receive ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
    CVS Health (08/27/25)
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  • PS Medical Review Coordinator

    University of Utah (Salt Lake City, UT)
    …**Requisition Number** PRN42418B **Job Title** PS Program Assistant **Working Title** PS Medical Review Coordinator **Job Grade** C **FLSA Code** Nonexempt ... us and help give the gift of sight! The Medical Review Coordinator at the Utah Lions...for transplantation. This role involves completing donor charts, reviewing medical records , and applying knowledge of … more
    University of Utah (08/07/25)
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  • Medical Review Coordinator II - Rral

    Prime Healthcare (Gadsden, AL)
    …Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely with CMO (Chief ... being met; gathering data and responding to request for records from payers/fiscal intermediary etc.; gathering clinical and fiscal...or Nursing Graduate required. 2. Three years of Utilization Review experience as a Medical Review more
    Prime Healthcare (08/28/25)
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  • Utilization Management Nurse Consultant…

    CVS Health (Springfield, IL)
    …skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and ... Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. +...close on: 09/12/2025 Qualified applicants with arrest or conviction records will be considered for employment in accordance with… more
    CVS Health (08/31/25)
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  • Senior Manager, US Medical Information…

    Takeda Pharmaceuticals (Lexington, MA)
    …matter expert representative at Regional Medical Strategy Team meetings. + Medical review of other materials pertinent to Takeda business as required, ... the role:** Join Takeda as a Senior Manager, US Medical Information and Review where you will...both pre- and post-marketing research studies. * Proven track record of teamwork, leadership, timely decision making and results… more
    Takeda Pharmaceuticals (08/15/25)
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  • Temporary, Utilization Review

    Commonwealth Care Alliance (Boston, MA)
    …to the Senior Medical Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing ... **Essential Duties & Responsibilities:** + Primary responsibility for performing daily medical reviews, appeals as appropriate, correspondence regarding review more
    Commonwealth Care Alliance (08/20/25)
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  • Medical Consultant Review

    ABBTECH Professional Resources, Inc. (Reston, VA)
    …an accident, as well as future pain and suffering/treatment needed. The individual's medical records include crush injuries; a coma; TBI; crushed vocal chords; ... 1 year of experience in providing professional expertise to DoD preferred. * Medical Expert in orthopedic rehabilitation with vocal cord atrophy as secondary skill.… more
    ABBTECH Professional Resources, Inc. (08/23/25)
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  • Utilization Review Nurse, Evening shift

    Houston Methodist (Houston, TX)
    …is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent medical record review for medical necessity and level of ... or concurrently determines the appropriateness of inpatient or observation services following review of relevant medical documentation, medical guidelines,… more
    Houston Methodist (08/29/25)
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  • Special Investigation Unit (SIU) Coding…

    CVS Health (Bismarck, ND)
    …legal, compliance, or rework projects. + Ensure staff provide detailed written summaries of medical record review findings and ensure the team articulates ... in determining correct coding and appropriate documentation during the review of medical records . This...+ A minimum of 5 years of experience in medical record review for coding… more
    CVS Health (08/08/25)
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  • Manager, Utilization Review

    Children's Mercy Kansas City (Kansas City, MO)
    …management of patients, including patient statusing processes, ongoing monitoring of medical necessity review functions utilizing InterQual and/or MCG screening ... quality, and Lean process improvements, and facilitating the quarterly Utilization Review Committee meetings. Provides evidence based and outcome focused family… more
    Children's Mercy Kansas City (06/17/25)
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