- Novant Health (Wilmington, NC)
- What We Offer Why This Role Matters As a Utilization Review Support Specialist, you will provide administrative and operational support to the UR-Revenue Recovery ... NC. + Provide administrative and technical support to the Utilization Review team to ensure timely payer communication, authorization tracking, and accurate… more
- Medical Center Hospital (Odessa, TX)
- Position Summary: The Utilization Review Specialist/Outcomes Specialist conducts concurrent and retrospective review functions in support of the hospital ... Utilization Review Program and makes appropriate referrals to designated Physician Advisors. Qualifications: A. Education: Holds a current Texas license as a Registered Nurse OR a current Texas Licensed Vocational Nurse. B. Training and Experience: Three… more
- CVS Health (IA)
- …Medicare sales and marketing guidelines. The Senior Manager, Agent Oversight & Material Review role is critical in ensuring compliance with State and CMS regulations ... evolving State and CMS guidance, manage the Agent Oversight and Material Review improvement processes and provide leadership with timely updates on implementation… more
- US Tech Solutions (Chicago, IL)
- …clinical policy, regulatory and accreditation guidelines. + Responsible for the review and evaluation of clinical information and documentation. + Reviews ... knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT...Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse… more
- Addiction Recovery Care (Ashland, KY)
- …stewardship are key elements of every thing we do! We are hiring a Utilization Review Clinician for our growing team! The Utilization Review Clinician is to ... + Perform initial, concurrent, and retrospective reviews utilizing concurrent review forms and/or medical notes, clinical notes, medication lists, and/or… more
- New York State Civil Service (Delmar, NY)
- …The Protection Of People With Special Needs Title Quality Care Facility Review Specialist 1 Occupational Category Health Care, Human/Social Services Salary Grade 18 ... Under the general supervision of a Quality Care Facility Review Specialist 2, the Quality Care Facility Review... Review Specialist 2, the Quality Care Facility Review Specialist 1 will perform the following duties:* Conduct… more
- Baystate Health (Springfield, MA)
- …Midpoint - Maximum $87,859.00 - $100,984.00 - $119,412.00 **UM Outpatient Clinical Review Nurse- Baystate Health, Health New England** **This is a full-time** ... **.** **Current States Eligible MA and CT** The **UM Outpatient Clinical Review Nurse** contributes to the overall success of the Utilization Management department… more
- Molina Healthcare (Houston, TX)
- JOB DESCRIPTION **Job Summary** The RN Care Review Clinician provides support for clinical member services review assessment processes. Responsible for verifying ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- Citigroup (Wilmington, DE)
- …strategy **.** This position is part of the Artificial Intelligence (AI) Review Team within Citi's Model Risk Management (MRM) organization. This position will ... perform independent review and effective challenge of all lifecycle activities of Generative AI and Unsupervised Learning models used in Citi. **Responsibilities** :… more
- Hawaii Pacific Health (Honolulu, HI)
- …patient service representatives who are fluent in Japanese and English. As the Medical Review Officer Assistant (MROA), you will form an integral part of our Doctors ... experience. Two (2) years of clinic experience. **Preferred Qualifications:** Medical Review Officer - Assistant (MRO-A) Certification through the Medical Review… more