- Highmark Health (Tallahassee, FL)
- …NCQA, URAC, CMS, DOH, and DOL regulations at all times. In addition to utilization review , the incumbent participates as the physician member of the ... **JOB SUMMARY** This job, as part of a physician team, ensures that utilization management responsibilities are performed in accordance with the highest and most… more
- University of Utah (Salt Lake City, UT)
- …demonstrated human relations and effective communication skills also required. Knowledge of utilization review and quality assurance procedures is preferred. An ... demonstrated human relations and effective communication skills also required. Knowledge of utilization review and quality assurance procedures is preferred. An… more
- HCA Healthcare (El Paso, TX)
- …and retrospective review of patient medical records for purposes of utilization review , compliance with requirements of external review agencies ... Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review /quality assurance, use of InterQual(R) or other… more
- HCA Healthcare (Salt Lake City, UT)
- …sessions as well as conduct psychotherapy process groups. SW-MSW also perform utilization review functions, including conducting InterQual reviews and obtaining ... + 2 or more years of clinical experience preferred. + Knowledge of Utilization Review , DRG review , and Discharge Planning preferred. For 150 years, St.… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review /Medical and Case Management services for Workers' Compensation. The Workers' ... disability services for timely return to work. + Provides case management, utilization review , continued stay reviews, and based on clinical judgment and state… more
- Children's Home Healthcare (Amarillo, TX)
- …authorizations for Home Health services from insurance company. 7. Attend quarterly Utilization Review meetings as designated by the Director of Professional ... on a 60 days basis per company policy. 9. Review /approve plan of care and all related documents prior...skills and willing to travel to patient homes + Utilization Management Experience + Reliable transportation for patient visits… more
- University of Southern California (Los Angeles, CA)
- …+ Req 5 years Clinical experience + Req 2 years Ambulatory case management or utilization review experience within the last three years + Req Ability to work ... The role integrates the functions of complex case management, utilization management, quality management, discharge planning assessment, and coordination of… more
- New York State Civil Service (Newburgh, NY)
- …experimental psychology, research psychology, industrial psychology, organizational psychology, utilization review , guidance counseling, etc.Psychologist 2:You ... psychology, research psychology, industrial psychology, organizational psychology, health psychology, utilization review , guidance counseling, pastoral counseling, or… more
- Actalent (Sacramento, CA)
- …(eg, med-surg, telemetry, ICU) + At least 1 year of experience in utilization review , case management, or hospital discharge planning + Familiarity with ... within 50 miles of the Sacramento area Job Duties + Perform timely utilization reviews for Medicare inpatient admissions, continued stays, and discharges + Apply CMS… more
- University of Washington (Seattle, WA)
- …one of the following: certified healthcare chart auditor, certified professional in utilization review (or utilization management or healthcare management), ... communications thoroughly, and communicated payer decisions in a timely manner + Review clinical denials and initiate appeals process + Conduct medical necessity… more
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