- Actalent (Orlando, FL)
- …to validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual ... Job Title: Clinical Review Nurse Job Description As a Clinical ...Texas nursing license. Work Environment This is a fully remote position with working hours from 10 am to… more
- Henry Ford Health System (Troy, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... Science Nursing required OR four (4) years Case Management/ Appeal/ Utilization Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES… more
- Henry Ford Health System (Troy, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Epic preferred. Additional Information + Organization: Corporate Services + Department: Central Utilization Mgt + Shift: Day Job + Union Code: Not Applicable… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …mentorship, _development,_ and leadership programs + And more **Description** The ** Utilization Review (UR) Specialist** is a Registered Nurse responsible ... may be required. Work Type: This position is a remote position outside traditional office, often from home or...experience or a minimum of two years of previous utilization review experience. + Licensure - Must… more
- Centene Corporation (Salem, OR)
- …substance abuse addiction disorders experience is required. + Direct experience with Utilization Review or Utilization Management related to Behavioral ... offering competitive benefits including a fresh perspective on workplace flexibility. ** Remote Call Center Environment - Coverage: 365/24 -7** **Required Days:… 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 ... a fresh perspective on workplace flexibility. **Position Purpose:** Performs a clinical review and assesses care related to mental health and substance abuse.… more
- AmeriHealth Caritas (LA)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review Specialist to our growing team. The Utilization ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans required. Knowledge of ABA services and BH utilization review process required. Experience working with providers and healthcare ... benefits including a fresh perspective on workplace flexibility. NOTE: This is a fully remote role. Preference will be given to applicants who reside in Florida, who… more
- Monte Nido (Miami, FL)
- …save lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** ** Remote - EST or CST ... provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting...billing and account follow-up. This is a Full Time remote position supporting our virtual programs on East and… more