- CVS Health (Phoenix, AZ)
- …+ Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization . ** Remote Work Expectations** + This is a 100% ... + Clinical experience in ER, ICU, or Critical Care preferred. + Managed Care/ Utilization Management experience. + Experience with Claims Review processes +… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... times may vary based on business needs. Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- Highmark Health (Harrisburg, PA)
- …+ Medical/Surgical experience + Utilization Management (UM) or (UR) Utilization Review experience **LICENSES AND CERTIFICATIONS** **Required** + Current ... Inc. **Job Description :** **JOB SUMMARY** This job implements effective utilization management strategies including: review of appropriateness of health… more
- Cognizant (Salem, OR)
- **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
- CVS Health (Columbus, OH)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team **Position ... 8:00am-5:00pm EST (Shift times vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc. (AHH), a division… more
- Highmark Health (Bismarck, ND)
- …determination for prior authorization review and appeals. Through the Utilization Review system, the incumbent evaluates clinical information provided by ... requests for prior authorization or appeals against medical policy through the Utilization Review system. Update the system records appropriately to ensure… more
- Integra Partners (Troy, MI)
- …operational needs require. The Senior MD provides clinical oversight to the Utilization Review Medical Director(s), ensures consistent application of criteria, ... Integra's clinical position to internal and external stakeholders. The Senior Utilization Review Medical Director's responsibilities include but are not… more
- 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
- Integra Partners (Troy, MI)
- The Utilization Review Medical Director is responsible for conducting clinical reviews of Durable Medical Equipment (DME) and related requests to support ... and are committed to consistency, compliance, and evidence-based decision making. The Utilization Review Medical Director 's responsibilities include but are not… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role We're looking for a Utilization Review (UR) Nurse to join our team and support high‑quality, cost‑effective ... patient care from a fully remote environment. This role is ideal for nurses who...ensure appropriate levels of care. Key Responsibilities + Conduct utilization reviews for inpatient, outpatient, and ancillary services using… more