- Houston Methodist (Sugar Land, TX)
- …the Senior Denials Management Specialist position is responsible for performing utilization review activities, and monitoring the clinical denial management ... Seven years clinical nursing/patient care experience which includes three years in utilization review , case management or equivalent revenue cycle clinical role… more
- Corewell Health (Royal Oak, MI)
- …patients. 1. Identifies patients that need care management services (ie utilization review ; care coordination; and/or discharge/transition planning). 2. ... years of relevant experience Three to five years' experience in care management, utilization review , home care and/or discharge planning. Preferred + Registered… more
- Penn Medicine (Philadelphia, PA)
- …the hospital through teaching, consulting, and advising the care management and utilization review departments and the hospital leadership. The Physician Advisor ... changes in payer rules including CMS rules as it pertains to utilization review * Recommend and request additional and more complete medical record documentation… more
- CVS Health (Phoenix, AZ)
- …partial hospitalization and intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or prior authorization. + ... for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team....a computer. + Flexibility to provide coverage for other Utilization Management (UM) Nurses across various UM specialty teams… more
- UPMC (Pittsburgh, PA)
- …for various clinical and non-clinical disciplines across UPMC, including regular utilization review , spend analysis, product introductions and trials. + ... Supports clinical specialty committees focused on product introductions, value analysis and utilization review consistent with UPMC policies and procedures. +… more
- Hartford HealthCare (Manchester, CT)
- …Region serves a region of 300,000 people in 19 towns. POSITION SUMMARY: The Utilization Review Case Manager (UR CM) works in collaboration with the physician ... of care in the acute-care setting. * Minimum of 1 year Utilization Review experience preferred via industry clinical standards, ie, InterQual, Milliman Care… more
- Sharp HealthCare (San Diego, CA)
- …position requires the ability to combine clinical/quality considerations with regulatory/financial/ utilization review demands to assure patients are receiving ... nursing experience or case management experience. + 3 Years case management, utilization review , care coordination experience. + California Registered Nurse (RN)… more
- Centene Corporation (Cheyenne, WY)
- …management, cost containment, and medical quality improvement activities. + Performs medical review activities pertaining to utilization review , quality ... physician education with respect to clinical issues and policies. + Identifies utilization review studies and evaluates adverse trends in utilization of… more
- Molina Healthcare (AZ)
- …in preparation for national committee for quality assurance (NCQA) and utilization review accreditation commission (URAC) certifications. * Provides leadership ... of health care services provided to plan members. * Supports plan utilization management program and accompanying action plan(s), which includes strategies to ensure… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …+ Knowledge of NCQA UM accreditation requirements, Massachusetts, and Rhode Island utilization review regulations + Proficiency in Microsoft Office (Word, Excel, ... utilization management regulatory and accreditation standards, such as NCQA, Massachusetts utilization review regulations, Rhode Island utilization … more