- Guthrie (Troy, PA)
- …Packer Hospital Business Office, is responsible for the coordination of Utilization Management (UM) processes and requirements of prior ... Up to a $15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer, in collaboration with Care Coordination, Guthrie Clinic offices, other… more
- BriteLife Recovery (Englewood, NJ)
- What you will be doing? The Utilization Review (UR) Specialist is a critical member of the administrative team at Advanced Revenue Solutions and is responsible for ... overseeing and coordinating all aspects of utilization review and insurance authorization for clients receiving substance use disorder (SUD) treatment at Britelife… more
- Centene Corporation (San Antonio, TX)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- AmeriHealth Caritas (LA)
- …Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon to: +...home healthcare or a medical office setting. + Previous prior authorization experience is required.; + Proficiency in Electronic… more
- AdventHealth (Glendale Heights, IL)
- …Glendale Heights, IL 60139 **The role you'll contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use clinical expertise by ... strategies including concurrent payer communications to resolve status disputes. The Utilization Management Nurse is accountable for a designated patient caseload… more
- CVS Health (Richmond, VA)
- …concurrent review, and appeal request. This position is primarily responsible for Utilization Management, including prior authorization as well as concurrent ... Aetna's Northeast region but may support other plans when needed. This UM ( Utilization Management) Medical Director will be a "Work from Home" position primarily… more
- Intermountain Health (Murray, UT)
- …research. + Coordinates, manages, and monitors pharmacy claims processing services, utilization management, and prior authorization protocols. + Conducts Drug ... Utilization Review projects as appropriate, which includes ability to query and analyze pharmacy data. + Oversees Clinical Coordinators, pharmacy residents and student activities. + Promotes stand-alone PBM through relationships with customers, brokers,… more
- CVS Health (Hartford, CT)
- …AHH is URAC accredited in Case Management, Disease Management and Utilization Management. AHH delivers flexible medical management services that support ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Utilizes clinical experience and skills in a collaborative… more
- Centene Corporation (Raleigh, NC)
- …to ensure level of care and services are medically appropriate + Performs prior authorization reviews related to mental health and substance abuse to determine ... discharge planning + Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members and their families… more
- Banner Health (CO)
- …benefits, health and dental plan inquiries, and services of staff such as utilization review, prior authorization, billing and contract management. 6. Services ... inbound and outbound customer and staff communications for all facilities in the states in which they operate. Works with various departments and staff to provide accurate managed care information. MINIMUM QUALIFICATIONS High school diploma/GED or equivalent… more