- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible ... for conducting thorough medical necessity reviews to assist with determining appropriate patient...experience or a minimum of two years of previous utilization review experience. + Licensure - Must… more
- Baptist Memorial (Memphis, TN)
- …of Position and Scope of Responsibility Job Summary The Utilization Review Nurse is responsible for evaluating the medical necessity and appropriateness ... of healthcare services and treatment as prescribed by utilization review standards. The UR Nurse works with providers, insurance companies and patients to ensure… more
- UnityPoint Health (Cedar Rapids, IA)
- …a working knowledge of financial and reimbursement processes to facilitate medical cost management, including best practices, effective utilization of ... S + Shift: 40 Hours Per Week + Job ID: 168048 Overview The Utilization Management Specialist in the Behavioral Health Hospital Outpatient Departments serves a key… more
- Covenant Health (Nashua, NH)
- …health care team. + Annual goals are achieved. + Attends pertinent case management/ utilization review programs to maintain current knowledge of UR practices. + ... medical necessity reviews in accordance with the Utilization Management (UM) plan for patients that are housed...+ Maintains/enhances professional development/skills required to function as a Utilization Review Case Manager + Completes all… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible ... for overseeing and coordinating all aspects of utilization review and insurance authorization for clients...The UR Specialist works closely with clinical staff, admissions, medical providers, and third-party payers to support patient access… more
- Sutter Health (Sacramento, CA)
- …and case management within a managed care environment. + Comprehensive knowledge of Utilization Review , levels of care, and observation status. + Some awareness ... develop expertise on matters regarding physician practice patterns, over- and under- utilization of resources, medical necessity, documentation best practices,… more
- Centene Corporation (Salem, OR)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national...- 8 pm (CST)** **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Providence (Napa, CA)
- **Description** Care Manager RN - Utilization Review unit at Providence Queen of the Valley Medical Center in Napa, CA. This position is Full-Time and will ... Schedule:** Full time **Job Shift:** Day **Career Track:** Nursing **Department:** 7810 UTILIZATION REVIEW **Address:** CA Napa 1000 Trancas St **Work… more
- Nuvance Health (Danbury, CT)
- …other duties as required. Education: ASSOCIATE'S LVL DGRE Required: 3 Years of Utilization Review experience(or a certification ACMA, MCG, Interqual) Required : ... and providing timely and accurate clinical information to payors. Utilization management provides clinically based first level medical...and case does not meet criteria per first level medical necessity review , discuss case with the… more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering… more