- 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
- Martin's Point Health Care (Portland, ME)
- …Summary The Supervisor is responsible for day-to-day operations of the utilization review clinical team, in the areas of authorization requests, ... organizational determinations/ disputes, and auditing/training of utilization review staff. Regularly monitors daily workload, volumes, metrics, production, and… more
- Centene Corporation (Austin, TX)
- …for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering ... COMPACT LICENSE STRONGLY PREFERRED **Position Purpose:** Supervises Prior Authorization, Concurrent Review , and/or Retrospective Review Clinical Review team… more
- CareFirst (Baltimore, MD)
- …accreditation standards and federal/state regulations and general principles relating to utilization review . + Computer skills, including Microsoft Office ... & Qualifications** **PURPOSE** : Supervise the daily operations of the utilization management (UM) department functions to ensure appropriate coordination of health… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... to ensure appropriate level of care through comprehensive concurrent review for medical necessity of outpatient observation...Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor , the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... to collect all information necessary to perform a thorough medical necessity review . It is within the...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care organization desired… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …with Provider Relations, explaining processes for accessing Health Plan to perform medical review , obtains case or disease management support, or otherwise ... position is responsible for coordinating, integrating, and monitoring the utilization of physical health (PH) medical and...regulatory and accreditation entities. Refers appropriate cases to the Medical Director for review . Refer to and… more
- Covenant Health Inc. (Knoxville, TN)
- …meetings between physicians and payors as applicable. + Completes daily work lists for utilization review meeting the time frames set forth by Covenant Health. + ... times. Position Summary: The RN Utilization Management I will perform utilization management functions to include medical necessity reviews to promote a… 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