- Albany Medical Center (Albany, NY)
- …Day (United States of America) Salary Range: $71,612.39 - $110,999.20 Responsible for Utilization Management , Quality Screening and Delay Management for ... assigned patients. * Completes Utilization Management and Quality Screening for assigned patients.* Applies MCG criteria to monitor appropriateness of admissions… more
- Wellpath (Cleveland, OH)
- …care support. **How you make a difference** The Medical Director of Utilization Management leads and oversees utilization review , case management , ... appropriate utilization of medical services. The Medical Director of Utilization Management serves as a key liaison with external partners and stakeholders,… more
- US Tech Solutions (Columbia, SC)
- …established clinical criteria to service requests or provides health management program interventions. Utilizes clinical proficiency and claims knowledge/analysis to ... promote quality, cost effective outcomes. Performs medical or behavioral review /authorization process. Ensures coverage for appropriate services within benefit and… more
- BriteLife Recovery (Englewood, NJ)
- …assigned What we need from you? + Minimum of 2-3 years of experience in utilization review , case management , or insurance coordination in a behavioral health ... What you will be doing? The Utilization Review (UR) Specialist is a...Maintain compliance with payer policies, HIPAA regulations, and internal utilization management protocols. + Monitor trends in… more
- Cedars-Sinai (Los Angeles, CA)
- …more about you and your skills! **What will you be doing in this role?** The Utilization Review Case Manager validates the patient's placement to be at the most ... Manager follows the UR process as defined in the Utilization Review Plan in accordance with the...- PER DIEM - 8 Hour Days **Department** : Utilization Management **Business Entity** : Cedars-Sinai Medical… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental...preferably in a hospital setting + 2+ years of utilization management experience in a health plan… more
- UNC Health Care (Hendersonville, NC)
- … reviews in accordance with federal regulations and the health system's Utilization Review Plan. Responsibilities: + Uses approved criteria and conducts ... management referrals. Initiates appropriate social work referrals. + Performs utilization management assessments and interventions, using collaboration with… more
- Actalent (Rancho Cordova, CA)
- Utilization Review Nurse About the Role...2-3 years of clinical experience in prior authorization, case management , or utilization management + ... We're looking for a Utilization Review (UR) Nurse to join our...obtain additional clinical information when needed + Support denial management , including appeals and peer‑to‑peer review processes… more
- Providence (Olympia, WA)
- …Qualifications:** + Bachelor's Degree or Associate's Degree in Nursing + 3 years - Utilization Review , Care Management , Quality Management , and/or ... **Description** The Utilization Review (UR) Nurse has a...clinical background blended with well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient… more
- Integra Partners (Troy, MI)
- …funded programs; no current or past OIG or state sanctions + Experience performing utilization management or clinical review activities + Strong written and ... The Utilization Review Medical Director is responsible...Medical Equipment (DME) and related requests to support Integra's Utilization Management (UM) operations. This full-time, salaried… more