- 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
- Molina Healthcare (WI)
- …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
- Nuvance Health (Danbury, CT)
- …comprehensive, patient-centric vision and strategy for system-wide care coordination, encompassing utilization review (UR), denials management , discharge ... setting * Minimum of 5 years of progressive leadership experience in case management or utilization review * Proven leadership experience with a track record… more
- Hartford HealthCare (Hartford, CT)
- …The primary responsibility of the Metabolic and Bariatric Surgical/Medical Clinical Reviewer (MBSCR) is to ensure the accurate and timely collection, documentation, ... over the course of the patient's care through effective utilization of the hospital and surgeons' office record systems....departments, and others whose support is necessary for the management and success for the program. . Serves as… more
- Koniag Government Services (Germantown, MD)
- …Professional Services** , a Koniag Government Services company, is seeking a Document Reviewer Level 3 (DRL3) with a Top-Secret clearance to support KPS and our ... Services, a Koniag Government Services company, is seeking an experienced Document Reviewer Level 3 (DRL3) to conduct classification reviews in accordance with… more
- Ventura County (Ventura, CA)
- …evaluation, and review ; + Performs daily clinical reviews to support utilization and quality management , ensuring compliance with guidelines and standards ... The ideal candidate is an experienced Mental Health Nurse with a background in utilization review and discharge planning. They also have extensive years of… more
- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review + California Physicians and Surgeons License - Medical… more
- Sharp HealthCare (San Diego, CA)
- …of Authorization Review for Sharp Health Plan (SHP). The Physician Reviewer will perform all reasonably necessary functions to ensure quality of care and ... appropriate utilization in the most cost-effective, appropriate and professional manner,...of managed care and the process for prior authorization review . + California Physicians and Surgeons License - Medical… more
- Humana (Washington, DC)
- …. + Utilization management experience in a medical management review organization, such as Medicare Advantage, managed Medicaid, or Commercial ... 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
- University of Rochester (Rochester, NY)
- …discharge. Identifies problems that include but are not limited to pre-certifications, Utilization Management , Medicaid Pending, third party payer issues, and ... communication and follow-up with assigned area, Financial Assistance, Social Work, Utilization Management , Medicaid Enrollment & Outreach, patients, families,… more
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