- Corewell Health (Grand Rapids, MI)
- …of the guiding principles will be demonstrated through applications of evidence-based utilization review process and application of sound clinical judgement. The ... peer to peer clinical discussions, and participation in denials management which include review of previous clinical...management + Provide clinical oversight to nurse case management and utilization management . +… more
- Rochester Regional Health (Rochester, NY)
- …in the Care Management Data base to support the clinical review process. + Concurrently monitors resources utilization , performing continued stay reviews ... efficient utilization of resources. Carries out activities related to utilization management , discharge planning, care coordination and referral to other… more
- Koniag Government Services (Germantown, MD)
- …weapons design, nuclear material production, counterintelligence, weapon science, and military utilization of nuclear weapons to review and assess documents. ... Services, LLC,** a Koniag Government Services company **,** is seeking a Document Reviewer Level 5 (DRL5) with Top- Secret clearance to support **KPS** and our… more
- CVS Health (Phoenix, AZ)
- …+ Utilizes skills to coordinate, document and communicate all aspects of the utilization /benefit management program. + Evaluation of Members; Through the use of ... care management tools and information/data review , conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case… more
- Texas Health Resources (Plano, TX)
- …also providing quality medical care. 5. Support effective patient throughput, utilization management , and compliant documentation. MEDICAL STAFF GOVERNANCE: 1. ... Credentials Committee to coordinate medical staff credentialing including the review of credentials, delineation of clinical privileges, development of privileges,… more
- Ascension Health (Austin, TX)
- …setting (Adult Medicine Hospitialist experience preferred), preferably with some Physician Advisory/ Utilization Management work experience. If you are ready to ... of physicians apply today! **Responsibilities:** Work in areas of utilization management and denial mitigation, including but...and denial mitigation, including but not limited to: + Review medical records of identified patients to assist with… more
- Ellis Medicine (Schenectady, NY)
- …services provided by the Case Manager include, but are not limited to, utilization review , case management , care transition, collaboration with physicians ... years of inpatient experience in a hospital environment preferred. + Previous case management , utilization review , and discharge planning experience highly… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 2 (DRL2) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 2 (DRL2) to conduct classification reviews of documents and… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 1 (DRL1) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company is seeking an entry-level Document Reviewer Level 1 (DRL1) to conduct classification reviews of government agency… more
- Molina Healthcare (Kearney, NE)
- …candidate with a RN licensure, Diagnosis-Related Group (DRG) experience, 2 years of Utilization Review and/or Medical Claims Review experience. Knowledge in ... officer on denial decisions. * Resolves escalated complaints regarding utilization management and long-term services and supports...the specific programs supported by the plan such as utilization review , medical claims review ,… more