- Ivyhill Technologies LLC (Bethesda, MD)
- …nursing program. Must have three (3) years of clinical nursing experience. Referral Management (RM) and Utilization Management (UM) experience is preferred. ... Nurse (Non-Practicing) to support its contract with the Integrated Referral Management and Appointing Center (IRMAC), the National Capital Regions' premier… more
- BayCare Health System (Tampa, FL)
- …of trust, dignity, respect, responsibility and clinical excellence. **The Utilization Review Specialist Senior/RN responsibilities include:** + Functions ... Nursing or Business **Experience:** + Required 2 years in Utilization Review or + Required 2 years...Review or + Required 2 years in Case Management or + Required 3 years Registered Nurse +… more
- Dallas Behavioral Healthcare Hospital (Desoto, TX)
- The Utilization Review Case Manager is responsible for working with insurance companies and managed care systems for the authorization, concurrent and ... access the full range of their benefits through the utilization review process. + Conducts admission reviews....degree such as nursing, social work, psychology, health information management or other related healthcare field is preferred or… more
- State of Massachusetts (Boston, MA)
- …staff to ensure compliance with DMH regulations, policies, and procedures, including utilization management reviews, case management documentation, incident ... (HSC) I staff and assigns individuals referred for case management to HSC I staff ensuring the provision of...as needed. . *Staff Supervision and Development:*Assign and regularly review HSC I staff caseloads, provide regular case supervision… more
- US Tech Solutions (Topeka, KS)
- …for Healthcare. Health Services strategies, policies, and programs are comprised of utilization management , quality management , network management ... tools and resources. **Responsibilities:** - Through the use of care management tools and information/data review , conducts comprehensive evaluation of referred… more
- Hartford HealthCare (Farmington, CT)
- …CDI subject matter expert guidance to CDS team, coding, physician leadership, quality management , utilization management , all providers, and others as ... now have our own identity with a unique payroll, benefits, performance management system, service recognition programs and other common practices across the… more
- HonorHealth (AZ)
- …here -- because it does. Learn more at HonorHealth.com. Responsibilities Job SummaryThe Utilization Review RN Specialist reviews and monitors utilization of ... quality cost-effective care. Ensures appropriate level of care through comprehensive review for medical necessity of extended stay, outpatient observation, and… more
- CDPHP (Latham, NY)
- …two (2) years experience in a health insurance related discipline required. + Utilization management experience is preferred. + Knowledge of managed care, health ... to logging and routing requests for authorization to the appropriate clinical reviewer . CSS reviews clinical documentation and determines at times what is being… more
- Sedgwick (Nashville, TN)
- …a Great Place to Work(R) Fortune Best Workplaces in Financial Services & Insurance Utilization Review Coordinator **PRIMARY PURPOSE** : To assign utilization ... **ESSENTIAL FUNCTIONS and RESPONSIBILITIES** + Accesses, triages and assigns cases for utilization review (UR). + Responds to telephone inquiries proving… more
- CenterWell (Atlanta, GA)
- …opportunities for education/coaching + Identifying trends and areas of opportunity in pharmacy utilization (pharmacy management ) to impact Part D per Member per ... is responsible for executing the clinical strategy through the management of their own patient panel as well as...inquiries, requests, and complaints from patients + Ongoing chart review / audit of clinical staff to ensure quality… more