- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership and ... growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming,...Serve as the lead for CCA's Utilization Review functions working closely with other medical … more
- UPMC (Pittsburgh, PA)
- The Regional Medical Director, CC/DP and Utilization Review , provides clinical and management leadership across multiple hospitals within the region. This ... , and length of stay (LOS) strategic oversight. The Medical Director will report to the Vice President of...care organizations, providers, and payers to address benefit coverage, utilization review , and quality assurance. + Promote… more
- Molina Healthcare (NM)
- …Care Access and Monitoring team responsible for prior authorizations, inpatient/outpatient medical necessity/ utilization review , and/or other utilization ... + Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of InterQual / MCG guidelines.… more
- Saint Luke's (Kansas City, MO)
- … RN is responsible for assuring the receipt of high quality, cost efficient medical outcomes through utilization review and management. This position ... using clinical guidelines (InterQual). + Complies with CMS regulation regarding utilization review /management. + Obtains and manages insurance authorizations and… more
- Monte Nido (Miami, FL)
- …authorization, potential denials, and potential for private payment. + Follow workflow and medical record requirements for utilization review and clinical ... while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote** **Monte Nido has been… more
- CVS Health (Columbus, OH)
- … journeys. As a Utilization Management (UM) Nurse Consultant specializing in Medical Review , you'll play a vital role in ensuring members receive timely, ... phone, computer, etc. and clinical documentation systems. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Commitment to… more
- CVS Health (Boise, ID)
- …(RN) - active license. + 3+ Years of clinical experience. + 1+ Year of Utilization Review Management and/or Medical Management experience. + Must have active ... skills in a collaborative process to implement, coordinate, monitor and evaluate medical review cases. + Applies the appropriate clinical criteria/guideline and… more
- The County of Los Angeles (Los Angeles, CA)
- …recommendations on potential areas for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the committee of new or ... REQUIREMENTS: OPTION I:One year of experience performing the duties of a Utilization Review Nurse* or Medical Service Coordinator, CCS.** -OR- OPTION II:… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team....+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
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