- TEKsystems (Charlotte, NC)
- …8 AM-5 PM CST Quality Assurance Responsibilities: + Perform quality assurance review of peer review reports, correspondences, addendums, or supplemental reviews. ... and specifications are followed and all questions addressed. + Verify each review is supported by current clinical citations and references from reputable medical… more
- Centene Corporation (Austin, TX)
- …a fresh perspective on workplace flexibility. **Centene is hiring a Remote Clinical Review Nurse - Prior Authorization** to support our **Duals team** . ... preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN -… more
- Tenet Healthcare (Detroit, MI)
- …national standards for case management scope of services including: Utilization Management supporting medical necessity and denial prevention. Transition ... underutilization, q) and other duties as assigned. POSITION SPECIFIC RESPONSIBILITIES: Utilization Management : Balances clinical and financial requirements and… more
- CVS Health (Springfield, IL)
- …Prior Authorizations, Coordination with PCP and Specialty providers, Condition Management information and education, Medication management , Community Resources ... frontline advocates for members who cannot advocate for themselves. The TOC team will review prior claims to address potential impact on current case management … more
- Ventura County (Ventura, CA)
- …candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of experience ... evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards… more
- ChenMed (Houston, TX)
- …engagement with patient and family. + Facilitates patient/family conferences to review treatment goals and optimize resource utilization ; provides family ... we need great people to join our team. The Nurse Case Manager 1 (RN) is responsible for achieving...achieving desired clinical outcomes within specific timeframe. + Conducts review for appropriate utilization of services from… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Case Management . + Determines appropriate care level and resource utilization for complex cases. + Facilitates discharge planning and evaluates alternative ... educator, Pediatric Nursing, Gerontological Nursing, Maternity Nursing, Population health, Disease Management . + Current licensed Registered Nurse (RN) with… more
- WellSpan Health (Chambersburg, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation… more
- WellSpan Health (Lebanon, PA)
- …in the management of patient care between visits. + Assists in the management of patient utilization of health care system and provides patient education ... and patient has been notified. Provides related education, counseling, ongoing review , and monitoring regarding diagnostic tests (ie, INR results in Anticoagulation… more
- US Tech Solutions (RI)
- …MUST HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF ... **Job Description:** + Responsible for the review and evaluation of clinical information and documentation....UTILIZATION MANAGEMENT EXP, pref. knowledge of Milliman/MCG. + MUST HAVE… more