- Walmart (Bentonville, AR)
- **Position Summary ** Walmart is seeking a Director, Governance Regulatory Review , to join the Enterprise & Regulatory Risk Management team. This role is a key ... program in collaboration with other assurance partners. The Director, Governance Regulatory Review is a valued member of the Enterprise & Regulatory Risk Management… more
- Molina Healthcare (Rio Rancho, NM)
- …and One Note. Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically necessary ... 2 years experience, including experience in hospital acute care, inpatient review , prior authorization, managed care, or equivalent combination of relevant education… more
- US Tech Solutions (May, OK)
- …clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews ... and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION MANAGEMENT EXP, pref.… more
- Actalent (Eagan, MN)
- …Company Job Description We are seeking a qualified Pharmacist to review Medicaid members' Utilization Management requests, including formulary exceptions, prior ... providers is also a key part of this position. Responsibilities + Review and evaluate Medicaid members' Utilization Management requests. + Apply clinical judgment… more
- BlueCross BlueShield of Tennessee (Chattanooga, TN)
- …provider and member appeals, denial interpretation for letters, retrospective claim review , special review requests, and UM pre\-certifications and appeals, ... utilizing medical appropriateness criteria, clinical judgement, and contractual eligibility\. + Various immunizations and/or associated medical tests may be required for this position\. **Job Qualifications** _License_ + Current, active unrestricted Tennessee… more
- Centene Corporation (Salem, OR)
- …discuss member care being delivered + Collects, documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in ... determinations or provide recommendations based on requested services and concurrent review findings + Assists with providing education to providers on utilization… more
- Leprino Foods (Lemoore, CA)
- At Leprino Foods, starting compensation for this role is QE Product Review Clerk V Rate$23.78 - $27.35 (Break in rates and $0.75 cents differential pay from 6PM - ... 5:59AM applies). Summary Description: The QE Review Clerk V is responsible for shipping all Corporate and Customer samples and supporting sample pulling duties. QE… more
- Actalent (Atlanta, GA)
- …GA Daily Onsite work and rotating weekend shifts Job Description: + Review and approve precertification and medical necessity for designated referrals, procedures, ... appeals, risk management). Qualifications: + 1+ years of utilization management / utilization review / case management experience is must + RN License in GA or… more
- BJC HealthCare (St. Louis, MO)
- …experience performing care for hospitalized patients + 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity + Must live ... care resources. **Responsibilities** + Uses clinical and analytical skills to review and interpret diagnostic test results to determine appropriateness of patient's… more
- American Express (Phoenix, AZ)
- …will you make an impact in this role?** The Manager GFCSU Quality Control Review position will report to the Director of Financial Intelligence Unit - Governance and ... and proficient manner. + Manage initiatives to expand and enhance quality control review processes and technology. + Undertake the identification of error trends and… more