- Spectrum Billing Solutions (Skokie, IL)
- …in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- CVS Health (Little Rock, AR)
- …on business needs) Travel Required up to 5% for meetings/audits. Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division of ... **Position Summary** The Associate Manager is responsible for oversight of Utilization Management staff. This position is responsible for the development and… more
- Prime Healthcare (Ontario, CA)
- …is actively seeking new members to join our corporate team! Responsibilities The Utilization review tech essentially works to coordinate the utilization ... all related correspondence to the respective EMR/ tracking tool. Utilization review tech will follow up on...an SME to support the UR tech team and remote counter parts with the specific processes as applicable.… more
- Cognizant (Carson City, NV)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Based on this role's business requirements, this is a remote position open to qualified applicants in United States.… more
- Molina Healthcare (GA)
- This position will offer remote work flexibility, however, the selected candidate must reside in the state of Georgia. This position will require RN Licensure. JOB ... services professionals in some or all of the following functions: utilization management, care management, behavioral health and other programs. Leads team… more
- CVS Health (Phoenix, AZ)
- …in ensuring members receive timely, medically necessary care through thoughtful clinical review and collaboration with providers. This fully remote position ... shifts: 9:00am-5:30pm, 9:30am-6:00pm, 10:00am-6:30pm, or 11:30am-8:00pm EST Hours) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH),… more
- Southwest Power Pool (Little Rock, AR)
- …and geographic location will all be considered during the hiring process. Principal, Grid Asset Utilization - Salary range $ 144,700 - $ 188,100 **Join our team as a ... Principal, Grid Asset Utilization !** We are seeking a Principal, Grid Asset ...pursuant to federal employment laws. For further information, please review the Know Your Rights (https://www.eeoc.gov/poster) notice from the… more
- Centene Corporation (Frankfort, KY)
- …a remote position.** **Ideal candidates will have experience in behavioral health utilization review and ability to work in Eastern or Central Time Zone.** ... abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with...plus holidays, and a flexible approach to work with remote , hybrid, field or office work schedules. Actual pay… more
- Molina Healthcare (Iowa City, IA)
- …(such as, reviewing prior authorization requirements, reviewing drug/provider utilization patterns and pharmacy costs management), clinical pharmacy services ... (such as, therapeutic drug monitoring, drug regimen review , patient education, and medical staff interaction), and oversight (establishing and measuring performance… more
- Centene Corporation (New York, NY)
- …requires NY RN Licensure as well as a State Issued NY ID.** **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... requiring authorization. Utilizes decision-making and critical-thinking skills in the review and determination of coverage for medically necessary health care… more