- Molina Healthcare (Houston, TX)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN in the state of Texas. You will be hired to join the inpatient review team doing ... requests within required timelines. + Refers appropriate cases to Medical Directors and presents them in a consistent and...+ Adheres to UM policies and procedures. + Occasional travel to other Molina offices or hospitals as requested,… more
- Transdev (Pearl City, HI)
- …for members needing to travel inter-island or out of state + Obtain, review , and approve required medical documentation authorizing long distance travel ... Transdev is seeking a customer-focused and detail-oriented Travel Specialist to support our Non-Emergency Medical...status + Reconcile monthly concur reports + Create various utilization and reconciliation reports monthly + Assist with call… more
- Molina Healthcare (Omaha, NE)
- …Experience Previous experience in Hospital Acute Care, ER or ICU, Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual ... within required timelines. + Refers appropriate prior authorization requests to Medical Directors. + Requests additional information from members or providers in… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- Global Foundries (Malta, NY)
- …their markets. For more information, visit www.gf.com . Summary of Role: The travel , Card and expense coordinator will oversee the administrative support across all ... travel , card, and expense activities. This individual will be...card status, renewals, and credit limits + Run and review delinquency reports monthly and follow up on late… more
- Molina Healthcare (IL)
- …stay for requested treatments and/or procedures. * Works collaboratively with the Utilization and Case Management departments to provide ABA/BHT services to Molina ... by reviewing Behavioral Health Therapy (BHT) assessments and treatment plans for medical necessity and BHT best practice guidelines. This includes but is not… more
- Houston Methodist (The Woodlands, TX)
- …the liaison to other medical staff committees that interface with the utilization review /management committee. Assist with the evaluation of the hospital's ... resources. This position is a key member and leader of the hospital's utilization review /management committee, which is charged with regulatory goals of ensuring… more
- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Guthrie (Troy, PA)
- …years of experience in an acute care setting with strong care management, utilization review , and payer knowledge. A Case Management certification or obtaining ... Director and other members of the healthcare team to provide appropriate medical management and resource utilization utilizing established/approved criteria. b)… more
- Sharp HealthCare (San Diego, CA)
- …in-patient Care Management program that includes initial and concurrent review ; case management/discharge planning activities. Responsible for operational planning ... consistent with existing policies and/or principles. Responsible for managing medical management activities to include tracking, trending and analyzing UM data.… more