- Shuvel Digital (Lawrenceville, NJ)
- …to make corrections and ensures accuracy for the days work. + Researches all utilization review claims for accuracy prior to billing on a timely basis. ... Medical Biller Remote Summary: Ensures responsibility for all aspects of...changing departmental demands. Notes: + Officially open to 100% remote . Still prefer onsite/hybrid because of training, but they… more
- Actalent (New York, NY)
- …main role will be utilizing your clinical skills to complete utilization management reviews (Prior authorizations, Coverage Exceptions, Quantity Limit exceptions, ... of 6 Month(s). Work Site :This is a fully remote position. Work Environment: + These are fully ...opportunity after peak season to complete training for and review specialized cases (ex: oncology, hepatitis C, and other… more
- CVS Health (Columbus, OH)
- …required. **Preferred Qualifications** + Crisis intervention skills preferred. + Managed care/ utilization review experience preferred. + Case management and ... and coordination of psychosocial wraparound services to promote effective utilization of available resources and optimal, cost-effective outcomes. **Position… more
- Providence (MT)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Providence (OR)
- …RN License: Oregon and Washington + 1 year Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits, which include review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- Actalent (Tempe, AZ)
- …to client plans contracting for clinical services. + Conduct clinical review , analysis, recommendation, decision, and documentation of prior authorization requests, ... medical exception requests, and appeal requests as required. + Review medication request guidelines for clinical appropriateness and operational efficiency. + Assist… more
- CVS Health (Phoenix, AZ)
- …with transferring patients to lower levels of care. + 1+ years' experience in Utilization Review . + CCM and/or other URAC recognized accreditation preferred. + ... each and every day. **Position Summary** **This is a remote work from home role anywhere in the US...is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that… more
- Prime Therapeutics (Lansing, MI)
- …drives every decision we make. **Job Posting Title** Clinical Staff Pharmacist Remote **Job Description** The Clinical Staff Pharmacist is responsible for the ... processing and documenting of Utilization Management requests (ie formulary exceptions, prior authorization, step...$51.92 - $88.46 based on experience and skills. To review our Benefits, Incentives and Additional Compensation, visit our… more
- Cordis (Miami Lakes, FL)
- …EMEA, and APAC) focusing on understanding, optimizing, and directing IT spend and asset utilization . This is a remote role within the continental US and will ... impact IT spend. + Conducting various forms of Cordis IT spend and utilization analysis supported by market data, internal and external benchmarks, and current… more
- NexTec Group (TX)
- …must be located in the United States or Canada. This is a remote role. Objectives (Key Outcomes): + Complete assigned tasks independently and may collaborate ... within alignment of the Statement of Work, Business Process Review (BPR) documentation, and NexTec methodology. + Maintain at...and NexTec methodology. + Maintain at least 75 percent utilization on an average annual basis. + Maintain Acumatica… more