- CommonSpirit Health (Englewood, CO)
- **Job Summary and Responsibilities** **Thi** **s is a remote position** The Utilization Management Physician Advisor II (PA) conducts clinical case reviews ... to all constituents.** **Key Responsibilities** + Conducts medical record review in appropriate cases for medical necessity of inpatient...such as Joint Operating Committee (JOC), as requested by Utilization Management or Care Management .… more
- Healthfirst (NY)
- …Medical Peer Reviewer will: + Maintain productivity standards. + Collaborate with Utilization Management and Care Management and medical departments as ... **Duties/Responsibilities:** + The Medical Peer Reviewer will assess/ review requests for authorization,...Medicine or Family Practice + Previous, relevant experience in utilization management and clinical practice + Knowledge… more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- Houston Methodist (Houston, TX)
- …while providing excellent customer/patient service. + Plays a leadership role in utilization review committee which includes identification of opportunities for ... and trends in the areas of care coordination, evidence- based practice, utilization management , and service excellence. Disseminates information and focuses the… more
- Jennie Stuart Medical Center, Inc. (Hopkinsville, KY)
- …and administering activities related to clinical review , discharge planning, resource utilization , and utilization review . Your primary goal will be ... to teamwork + Experience with InterQual criteria + Understanding of utilization management + Knowledge of CMS regulations + Ability to work autonomously… more
- Ventura County (Ventura, CA)
- …medical policy with the Health Care Agency Director and Insurance Administrator, Utilization Management staff and Quality Assurance Staff. + Participates, as ... surgical procedures, referrals, tests, medication approvals requiring authorization.) + Develops utilization management standards and guidelines for approval by… more
- Covenant Health Inc. (Knoxville, TN)
- …###@covhlth.com Responsibilities + Reviews providers' requests for services and coordinates utilization management review . + Reviews precertification ... Overview Utilization Management Specialist, Revenue Integrity and...audiences as necessary. + Completes daily work lists for utilization review meeting the time frames set… more
- Health Care Service Corporation (Chicago, IL)
- …to obtain multi-state licenses. **PREFERRED JOB REQUIREMENTS** **:** + Utilization review or utilization management experience **Telecommute:** This is a ... reviews in accordance with the medical contract and regulations, medical criteria, utilization review , and quality of care. **JOB REQUIREMENTS** **:** +… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... care or support in their home to improve their quality of life. Utilization Management Clinical Reviewer will assess and process all authorization requests… more
- Humana (Raleigh, NC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... their daily work. The Medical Director's work includes computer-based review of moderately complex to complex clinical scenarios, ...with prior experience participating in teams focusing on quality management , utilization management , case … more