- CVS Health (Lansing, MI)
- …5+ years of clinical practice experience in medical healthcare. + 3+ years Medical Review or Utilization Management experience. + 2+ years of experience with ... that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Position Summary** The… more
- Baylor Scott & White Health (Dallas, TX)
- …vary based upon position type and/or level **Job Summary** + You will review patient cases for medical necessity and establish service suitability. You'll educate ... plan and the provider's care coordination departments. Your expertise is needed to review medical necessity. + Working with the team, you'll verify medical records… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... Science Nursing required OR four (4) years Case Management/ Appeal/ Utilization Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES… more
- Virtua Health (Pennsauken, NJ)
- …UR Tech and AA to support UR and revenue cycle process.Position Responsibilities: Utilization Management* Utilizes Payer specific screening tools as a resource to ... resource group and payers.Documentation* Appropriate and complete documentation of clinical review and denial management in the case management documentation system… more
- UNC Health Care (Kinston, NC)
- …well-being of the unique communities we serve. **Summary:** This position facilitates utilization management processes to support the right care is provided at the ... movement of patients throughout the continuum of care by conducting concurrent review and proactively resolving care, service, or transition of care delays/issues as… more
- Beth Israel Lahey Health (Plymouth, MA)
- …using Interqual criteria. + Integrates clinical knowledge with billing knowledge to review , evaluate, and appeal clinical denials related to the care provided to ... years recent, broad clinical experience in the hospital setting + Experience with utilization management within the last 3 years required + An understanding of the… more
- Alameda Health System (Oakland, CA)
- …each individual in the classification. + Lead and manage a team of utilization review professionals providing guidance, training, and performance evaluations. + ... utilization reviews and determine program improvements. + Develop and implement utilization review policies and procedures in accordance with industry… more
- CommonSpirit Health (Phoenix, AZ)
- …+ Board Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. + Physician Advisor Sub-specialty ... Certification by the American Board of Quality Assurance and Utilization Review Physicians, Inc. (ABQAURP) preferred. **Required Minimum Knowledge, Skills &… more
- Ventura County (Ventura, CA)
- …Under direction, scheduled as needed to assist with patient care coordination and utilization review . The incumbent will be responsible to assist with evaluation ... Per Diem Registered Nurse II/III - Utilization Management VCMC Print (https://www.governmentjobs.com/careers/ventura/jobs/newprint/5009956) Apply Per Diem… more
- Centene Corporation (Phoenix, AZ)
- …Tempe and/or Tucson offices.** **Position Purpose:** Manages the behavioral health (BH) utilization review clinicians to ensure appropriate care to members. ... within utilization management. + Oversees the behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines +… more