- Northern Light Health (Bangor, ME)
- …dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review , and patients are documented, if appropriate. + ... understanding of benefit coverage and precertification/authorization, if appropriate. + Quality review procedures are followed to ensure accounts are brought to a… more
- Wellpath (Fayette County, PA)
- …staff and ensure adherence to clinical protocols + Oversee chronic care clinics, utilization review , and quality improvement initiatives + Collaborate with the ... key role in chronic care clinic oversight, pharmacy monitoring, and medical program review . **What you bring to the table** EDUCATION + Medical school graduate… more
- Cedars-Sinai (CA)
- …the established/communicated timeframe + Documents appropriate reviews for assigned patients using utilization review tool. + Provides telephonic review for ... identified contracted/private patients collaborates with on-site and/or outside reviewers. + Keeps patients informed of progress and provides information related to disease progression. + Collaborates with discharge planner to make orders and arranges for home… more
- Common Ground (Bingham Farms, MI)
- …a unique combination of customer service, crisis intervention, resource guidance, utilization review , mobile crisis oversite and dispatch, Behavioral Health ... to Common Ground. To learn more about this position, please review the job description: Common Ground Crisis Hub - Manager… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... and/or social determinant of health needs. Engage members and providers to review and clarify treatment plans ensuring alignment with medical benefits and policies… more
- PruittHealth (Albany, GA)
- …years industry experience in a managed care setting focused on experience in utilization review /case management and at least two years case management, home ... for each patient based on a thorough history and clinical record review , including the attending physician's plan, the recommendations of national guidelines, social… more
- HCA Healthcare (Dublin, GA)
- …Case Management is highly preferred.** + **Certification in Case Management or Utilization Review is preferred.** + **InterQual experience is preferred.** ... career path, we encourage you to apply for our RN Case Manager opening. We review all applications. Qualified candidates will be contacted by a member of our team.… more
- Health Care Service Corporation (Albuquerque, NM)
- …and decision-making skills. *PC and database experience. **PREFERRED JOB REQUIREMENTS:** * Utilization review experience. *MUST be licensed to practice at the ... Summary** This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members… more
- Actalent (Bridgewater, NJ)
- …+ Collaborate with healthcare providers to clarify prescriptions. + Utilize Drug Utilization Review (DUR) for patient prescription management. + Maintain a ... + Assist with daily workflow related to prescription order processing. + Review prescription orders for appropriateness and accuracy. + Verify orders processed by… more
- Northern Light Health (Bangor, ME)
- …dates, and times of conversations with businesses, insurances, managed care organizations, Utilization Review , and patients are documented, if appropriate + ... understanding of benefit coverage and precertification/authorization, if appropriate + Quality review procedures are followed to ensure accounts are brought to a… more