- Elevance Health (Morristown, NJ)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on a US ... years of managed care experience preferred. + Consulting experience preferred. + Utilization management experience preferred. + Master's Degree preferred. (MBA,… more
- Children's Home Healthcare (Albuquerque, NM)
- …authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional ... on a 60 days basis per company policy. 9. Review /approve plan of care and all related documents prior...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for… more
- Veterans Affairs, Veterans Health Administration (Gainesville, FL)
- …tools to monitor the success of those efforts. Work with the VA Utilization Management (UM) department staff to monitor the preadmission screening process ... by the VHA Education Loan Repayment Services program office after complete review of the EDRP application. EDRP Authorized: Former EDRP participants ineligible to… more
- Monte Nido (Eugene, OR)
- …continuity of care + Communicate with insurance providers for **pre-certification and utilization review ** + Collaborate on **discharge and aftercare planning** ... continuous care. + Communicate with insurance companies for pre-certification and ongoing utilization management needs. + Participate in discharge planning and… more
- Molina Healthcare (OH)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At ... on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member… more
- Molina Healthcare (Los Angeles, CA)
- …with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. **Required Qualifications** * At ... California residents preferred.** **EMERGENCY ROOM ADMISSIONS REVIEW NURSE** **_3-12 NIGHT SHIFT 7:30PM - 08:30AM PACIFIC HOURS NON EXEMPT, 3 days a week will… more
- Trinity Health (Boise, ID)
- …Day Shift **Description:** **GENERAL SUMMARY AND PURPOSE:** Provides hospital case management / utilization review and discharge planning collaboratively ... patient care as appropriate. Coordinates the hospital activities concerned with case management / utilization review and discharge planning. Adheres to… more
- Veterans Affairs, Veterans Health Administration (San Antonio, TX)
- …will be responsible for establishing imaging protocols; reviewing imaging requests; utilization management ; ensuring appropriate preps and medication are ... section, service or facility level committees/boards, when assigned. Serve as Peer Reviewer for the Protected Peer Review Committee, when assigned. Demonstrate… more
- Centene Corporation (Jefferson City, MO)
- …of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** RN - Registered ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
- Centene Corporation (Trenton, NJ)
- …Knowledge of NCQA, Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred. **License/Certification:** + LPN - ... 28 million members as a clinical professional on our Medical Management /Health Services team. Centene is a diversified, national organization offering competitive… more
Recent Jobs
-
CA - VP, Regional Insurance Consultant
- Covr Financial Technologies (San Francisco, CA)