- University of Miami (Miami, FL)
- …SCCC Business Operations has an exciting opportunity for a full time Utilization Review Case Manager to work to work remote . The incumbent conducts initial, ... concurrent and retrospective chart reviews for clinical utilization and authorization. The Utilization Review Case Manager coordinates with the healthcare… more
- Molina Healthcare (Kearney, NE)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... a plus. Work hours: Monday - Friday 8:00am- 5:00pm Remote position **Essential Job Duties** * Performs clinical/medical reviews...the specific programs supported by the plan such as utilization review , medical claims review ,… more
- Fallon Health (Worcester, MA)
- …of purpose:** The PA Nurse uses a multidisciplinary approach to review service requests (prior-authorizations), focusing on selected complex medical and psychosocial ... functional, and psychosocial information from the medical records on site, through remote electronic access, telephonically or by fax in a collaborative effort with… more
- Humana (Washington, DC)
- …health insurance, other healthcare providers, clinical group practice management. + Utilization management experience in a medical management review ... this knowledge in their daily work. The Medical Director's work includes computer based review of moderately complex to complex clinical scenarios, review of all… more
- University of Utah (Salt Lake City, UT)
- …( CPC , ACS , CCS -P/H, RHIA , or RHIT ). Preferences Knowledge of utilization review and quality assurance procedures as well as experience with InterQual or ... or religious beliefs that object to vaccinations. **Preferences** 1. Knowledge of utilization review and quality assurance procedures, as well as experience… more
- ChenMed (Miami, FL)
- …experience in Hospital medicine preferred + At least one (1) year of utilization review experience preferred **PAY RANGE:** $198,797 - $283,995 Salary **EMPLOYEE ... our team. The Physician Reviewer is the primary physician reviewer for Utilization Management/Clinical Appropriateness review cases in our organization. Other… more
- World Insurance Associates, LLC. (Miami, FL)
- … review analysis + Renewal rate and funding initial projections/modeling + Claims utilization review + Rate and contribution modeling + Benchmarking studies + ... self-funded arrangements. You'll prepare financial deliverables, model renewals, evaluate utilization trends, and support client decision-making with data-driven insights.… more
- University of Utah (Salt Lake City, UT)
- …demonstrated human relations and effective communication skills also required. Knowledge of utilization review and quality assurance procedures is preferred. An ... demonstrated human relations and effective communication skills also required. Knowledge of utilization review and quality assurance procedures is preferred. An… more
- Mount Sinai Health System (New York, NY)
- …Description** **Director Medical Affairs Operations-Medical Staff Services -Full-Time -Days ( Remote )** _Our flexible remote opportunities offer an excellent ... opportunity for those who flourish in a remote environment to achieve improved work/life balance as well...all matters related to medical staff governance, credentialing, peer review and performance management; + In collaboration with the… more
- Bowman (Westminster, CO)
- …and within company policies and procedures. + Provide work assignments and review performance to ensure the efficient, cost-effective utilization of staff. ... Team Lead to join our team in Bentonville, AR ( Remote ). At Bowman, we believe in creating opportunities for...execution. Manage people and processes to ensure effective execution. Review work produced by staff for quality assurance. +… more