- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR ...for medical care evaluation studies. + Attends Utilization Review Committee meetings to inform the ... I Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/4924333) Apply UTILIZATION REVIEW NURSE SUPERVISOR I Salary $111,656.88 -… more
- The County of Los Angeles (Los Angeles, CA)
- UTILIZATION REVIEW NURSE SUPERVISOR II...over the nursing staff engaged in utilization review activities at Los Angeles General Medical Center, ... Print (https://www.governmentjobs.com/careers/lacounty/jobs/newprint/2784979) Apply UTILIZATION REVIEW NURSE SUPERVISOR II Salary $118,457.04 - $177,314.88… more
- Centene Corporation (Atlanta, GA)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... perspective on workplace flexibility. **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review … more
- AmeriHealth Caritas (Washington, DC)
- …Systems to efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care ... the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services,… more
- Dignity Health (Woodland, CA)
- …Woodland, CA, with occasional onsite meetings in Woodland.** **Position Summary:** The Utilization Review LVN uses clinical judgement in providing utilization ... - Preps case thoroughly, concisely and clearly for physician review . Researches EMR, criteria, medical policy and...Performs Inter-Rater Reliability audits as directed by the UM Supervisor or Manager. - Performs audits of medical… more
- University of Utah Health (Salt Lake City, UT)
- …+ Coordinate and communicate real-time staffing changes in conjunction with the Hospital Supervisor . + Review open shift requests and secure coverage as needed. ... to reassign staff based on census and workload, adhering to the Nurse Utilization Policy. + Assist Hospital Supervisor and Nursing Leadership in identifying… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a ... to the Utilization Management Manager. * Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas,… more
- Helio Health Inc. (Syracuse, NY)
- …degree preferred. + Licensed/credentialed applicants preferred. + Two years of experience in utilization review in a hospital, health care, or managed care ... of federal and state regulations applicable to treatment and reimbursement. + Utilization review procedures and techniques. Our Comprehensive Employee Benefits… more
- Mount Sinai Health System (New York, NY)
- …State & Federal regulation. + Enters concurrent review information for Review Nurses in Allscripts + Obtains/Prepares Medical Records and other documentation ... **Job Description** **Insurance Specialist Mount Sinai West Utilization Mgmt FT Days EOW** To maintain front...record keeping. Responsible for accurate filing of records, obtaining medical records and mailing of both internal and external… more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... with members and providers to collect all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion to… more