- Prime Healthcare (Inglewood, CA)
- …and Clinical Coordinators. This leader will oversee all facets of utilization management, discharge planning, and care coordination to ensure patiens receive ... case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. Additionally,… more
- Monte Nido (Miami, FL)
- …while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician** **Monte Nido** **Remote - EST or CST hours** **Monte ... to provide comprehensive care within an intimate home setting. The Utilization Review **Clinician** is responsible for conducting daily administrative and… more
- Centene Corporation (New York, NY)
- …benefits including a fresh perspective on workplace flexibility. **Position Purpose:** The Utilization Review Nurse I provides first level clinical review for all ... determination of coverage for medically necessary health care services. Answers Utilization Management directed telephone calls; managing them in a professional and… more
- Elevance Health (Columbus, GA)
- ** Utilization Management Representative II** **Location : Virtual -** This role enables associates to work virtually full-time, with the exception of required ... so the 3 days per week will be during these hours.** The ** Utilization Management Representative II** is responsible for managing incoming calls, including triage,… more
- CVS Health (Tallahassee, FL)
- …day. **Position Summary** **Fully remote with requirement to reside in Florida.** + Utilization Management is a 24/7 operation and the work schedule may include ... in Florida + 3+ years of clinical experience + Utilization Management is a 24/7 operation and work schedule...(Teams, Outlook, Word, Excel, etc.) **Preferred Qualifications** + Previous prior authorization experience + Prefer RN FL Compact license… more
- Elevance Health (Louisville, KY)
- ** Utilization Management Representative I** **Virtual:** This role enables associates to work virtually full-time, with the exception of required in-person training ... unless an accommodation is granted as required by law._ " The ** Utilization Management Representative I** will be responsible for coordinating cases for… more
- CDPHP (Albany, NY)
- …these values and invites you to be a part of that experience. The Utilization Review (UR) Nurse is responsible for the clinical review and documentation for services ... requiring prior authorization. This includes approval determinations and appropriate exceptions,...a Registered Nurse. + Minimum of two (2) years Utilization Management experience is preferred. + Knowledge of coding/claims… more
- CenterWell (Augusta, ME)
- …Nursing License + A minimum of three years clinical RN experience; + Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization ... procedures + Compact License preferred + Previous experience in utilization management within Insurance industry + Previous Medicare Advantage/Medicare/Medicaid… more
- Actalent (Orlando, FL)
- …validate the necessity and setting of care. Essential Skills + Proficiency in utilization management and utilization review + Experience with Interqual and ... Medicare + Expertise in medical, acute care, concurrent review, and prior authorization + Knowledge of managed care and patient care Additional Skills &… more
- MVP Health Care (Rochester, NY)
- …To achieve this, we're looking for a **Medical Director, Post-Acute Care Utilization Management** to join #TeamMVP. If you have a passion for collaboration ... additional involvement in adjudicating pharmacy, prospective, concurrent and retrospective prior authorization requests for all lines of business. + Integral… more
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