- Idaho Division of Human Resources (Nampa, ID)
- Utilization Review and Nurse Educator - SHW Posting Begin Date: 2025/09/22 Posting End Date: 2025/10/20 Category: Nursing Work Type: Full Time Location: Nampa, ... and experiencedRegistered Nurse Seniorto take on a critical role in our Utilization Review , Performance Improvement, Nursing Education programs. This is an… more
- Catholic Health Services (Melville, NY)
- …ensure timely follow through. + Reviews providers' requests for services and coordinates utilization /appeals management review . + Assist Utilization and ... Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of… more
- CaroMont Health (Gastonia, NC)
- …license to practice in NC (NC license or multi-state (compact) license). Certification in Utilization Review / Management , Quality and/or Case Management ... to MCO via fax, Provider Link, or telephonically. Gathers and disseminates Utilization Management information to medical staff departments, Nursing departments,… more
- Spectrum Billing Solutions (Skokie, IL)
- …+ Understanding of mental and behavioral health treatment services. Utilization Review Specialist | Utilization Management Specialist | UR Specialist ... Utilization Review Specialist | ABA Utilization Review Specialist | ABA Utilization Management Specialist | ABA UR Specialist | Behavioral Health… more
- University of Utah Health (Salt Lake City, UT)
- …and as a team member. **Qualifications** **Qualifications** **Required** + One year Utilization Review or Case Management experience. **Licenses Required** ... + Demonstrated knowledge of payers, payer systems, cost effective utilization management and InterQual criteria. + The...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Penn Medicine (Philadelphia, PA)
- …care services. The Physician Advisor role includes teaching, consulting, and advising case management , utilization review and provider staff. The physician ... and all areas of resource management , case management , social services, and utilization management...ensure accurate reimbursement and compliance. Provides query support and review and helps to resolve any documentation discrepancies. +… more
- Monte Nido (Miami, FL)
- …are looking for a Director of Utilization Management to oversee the Utilization Management / Review team and function. This role with report to the SVP ... the opportunity for people to realize their healthy selves. **Director of Utilization Management ** **Monte Nido** **Remote** Monte Nido has been delivering… 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
- Saint Francis Health System (Tulsa, OK)
- …participates in the Patient Care Committee for patient care reviews, and in Utilization Review Staff Committee, providing data and contributing to improvement of ... support to the hospital and treatment team throughout the review of patients, their placement in various levels of...and benefits of patients, matching the level of care utilization . Assures compliance with Managed Care Behavioral Health standards… more
- Wellpath (Lemoyne, PA)
- …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