- Centene Corporation (Indianapolis, IN)
- …O-1, H-1B1, F-1, J-1, OPT, or CPT.** **Position Purpose** Manage the prospective review of high risk claims to ensure payment integrity and provide immediate ... on findings including high dollar claims, coaching for quality review claims and internal audits. Create ODS reports of...+ Manage the Claims Quality Analysts to perform quality review of completed high risk claims and provide immediate… more
- Community Health Systems (Franklin, TN)
- **Job Summary** The Utilization Review Coordinator ensures efficient and effective management of utilization review processes, including denials and appeals ... authorizations for hospital admissions and extended stays. The Utilization Review Coordinator monitors and documents all authorization activities, assists with… more
- State of Georgia (Fulton County, GA)
- Office of Engineering Services-GDOT Pro Civil Engineer 5-Design Review Engineer-ETP124 (PG-O) Georgia - Fulton - Atlanta ... accrued hours JOB SPECIFIC DUTIES: Under limited supervision, serves as Design Review Engineer for the Office of Engineering Services responsible for providing… more
- Dignity Health (Chandler, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- Dignity Health (Rancho Cordova, CA)
- …within the Greater Sacramento, CA region.** **Position Summary:** The Utilization Review (UR) LVN uses clinical judgement in providing utilization management (UM ... position may be assigned cases in pre-authorization areas, in skilled nursing facility review or in concurrent review . Responsibilities may include: - Manages… more
- Dignity Health (Gilbert, AZ)
- …the Director of Care Management, performs criteria-based concurrent and retrospective utilization review to support and encourage the efficient and effective use of ... Conducts admission and continued stay reviews per the Care Coordination Utilization Review guidelines to ensure that the hospitalization is warranted based on… more
- UNC Health Care (Kinston, NC)
- …for all audit and appeals work activities. Assists with documentation review to support the clinical documentation specialists and Patient Financial Services. ... Supports the Utilization Review Nurse team when necessary by applying established criteria...patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of… more
- MyFlorida (Tallahassee, FL)
- MANAGEMENT REVIEW SPECIALIST - SES - 73000265 Date: Nov 18, 2025 The State Personnel System is an E-Verify employer. For more information click on our E-Verify ... . Requisition No: 865381 Agency: Department of Revenue Working Title: MANAGEMENT REVIEW SPECIALIST - SES - 73000265 Position Number: 73000265 Salary: $61,050.00 -… more
- Wipfli LLP (Green Bay, WI)
- …professional home, Wipfli offers a career-defining opportunity. Responsibilities The Loan Review Senior Consultant has the opportunity to work either remote, hybrid, ... travel to client locations in IL and WI is required. Responsilibities: + Review samples of commercial loans to ensure acceptable credit standards are maintained and… more
- City of New York (New York, NY)
- …Principal Administrative Associate, who will function as a Medicaid Quality Control Case Review Supervisor who will: - Review the audit findings determined by ... the Quality Control Case Reviewers to ensure they are relevant and appropriate. Review the programs' responses to error findings and determine whether MAQC agrees or… more