- Geisinger (Lewistown, PA)
- …and efficiency results for assigned population. + Works to appropriately apply benefits and utilization management serving as a resource to the patient or member ... as part of a shared rotation. Don't worry, we'll review this in your interview. At least two (2)...have prior RN experience in a hospital setting. Case Management experience is preferred and not required. The successful… more
- University of Utah Health (Salt Lake City, UT)
- …education in healthcare or a related field. + One year of experience in a utilization review or case management environment. + Basic Life Support Health ... prepared and delegated by social work or nurse case management by coordinating with home care agencies, post-acute care...+ Documents activities and progress in medical charts, computer billing/ utilization systems, or in other ways as directed. +… more
- Nuvance Health (Danbury, CT)
- …the time of review . If unable to resolve, escalate to the PA and Utilization Review (UR) Leadership. * Coordinate with the care team in changing patient ... in Milliman and InterQual Guidelines required * Minimum of 2-3 years experience as Utilization Management Nurse in an acute care setting required, minimum of 4… more
- SUNY Upstate Medical University (Syracuse, NY)
- …Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, experience with ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
- US Tech Solutions (LA)
- …+ Minimum 3 years nursing experience with a minimum of 1 year in utilization management / prior authorization review experience. **Experience** : ... in a specialty area of the nursing field providing utilization management prior authorization reviews. Build strong...Utilization Management . Prior Authorization Review experience **About US Tech Solutions:** US Tech Solutions… more
- Highmark Health (Buffalo, NY)
- …**Job Description :** **JOB SUMMARY** This job captures all inbound inquires for utilization management review from providers and pharmacies. The incumbent ... the member, and then creates the case (data entry) in Highmark's Utilization Management system for Prior Authorization clinical review . Ensures all accurate… more
- Texas Health Resources (Arlington, TX)
- …Clinical psychiatric or chemical dependency experience Required and * 6 Months in case management or utilization review Required * Prior experience with EPIC ... and quality of the services provided by the organization are enhanced. Utilization management issues are identified and addressed by the appropriate… more
- UCLA Health (Santa Monica, CA)
- …of safe, high quality, efficient, and cost-effective care. You will also perform utilization review while assuring the delivery of concurrent and post-hospital ... License and BLS certification + Recent experience in case management , utilization management and discharge...Knowledge of a large university teaching hospitals Preferred: Strong Utilization Review experience and understanding of CMS… more
- Highmark Health (Buffalo, NY)
- …Description :** **JOB SUMMARY** This job captures all inbound phone inquires for utilization management review from providers and pharmacies. The incumbent ... coverage, creation of a prior authorization case in Highmark's Utilization Management system for Prior Authorization clinical review , status research, etc.… more
- CVS Health (Hartford, CT)
- …Automation Team supports the implementation of strategic initiatives for the Utilization Management (UM) Clinical Services organization. These initiatives ... other healthcare integration standards + Healthcare industry experience, especially in Utilization Management or clinical operations. + Familiarity with clinical… more