- Molina Healthcare (Tacoma, WA)
- …on set schedule) Looking for a RN with experience with appeals, claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support for clinical member ... services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- Molina Healthcare (Madison, WI)
- …JOB DESCRIPTION Job SummaryProvides support for clinical member services review assessment processes. Responsible for verifying that services are medically ... with multidisciplinary teams to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications * At least 2… more
- US Tech Solutions (Chicago, IL)
- …+ Do you have experience with Prior Authorization? + Do you have experience with Utilization Review ? + Do you have an Active Registered Nurse License? **About US ... HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. + MUST HAVE UM experience, inpatient utilization management review . + MUST HAVE 1 YEAR OF UTILIZATION … more
- US Tech Solutions (May, OK)
- …HAVE MANAGED CARE exp and Medicare/Medicaid knowledge. . MUST HAVE UM experience, inpatient utilization management review . . MUST HAVE 1 YEAR OF UTILIZATION ... clinical policy, regulatory and accreditation guidelines. . Responsible for the review and evaluation of clinical information and documentation. . Reviews… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/236788/outpatient- clinician arrive-together/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt.… more
- Atlantic Health System (NJ)
- …chart documentation. 8. Incorporates use of criteria sets in context of utilization management. 9. Performs other related duties as assigned. Required:1. Master's ... - Becker's Healthcare + 100 Accountable Care Organizations to Know - Becker's Hospital Review + Best Employers for Workers over 50 - AARP + Gold-Level "Well… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/222342/outpatient- clinician /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Clare's… more
- Prime Healthcare (Boonton Township, NJ)
- …meetings as required to ensure continuity of care. Completes all required utilization review tasks as assigned. For Outpatient and Residential services/programs ... Connect With Us! (https://careers-primehealthcare.icims.com/jobs/231956/outpatient- clinician /job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilitySt. Clare's… more
- CVS Health (Frankfort, KY)
- …with heart, each and every day. **Position Summary** This is a fully **remote** Utilization Review Clinical Consultant. **Must reside in the state of Kentucky or ... the standard schedule based on business needs **Preferred Qualifications** + Managed care/ utilization review experience + Foster Care population experience +… more
- Point32Health (MA)
- … management and care management principles. Health Plan experience performing utilization review activities. Experience with McKesson's InterQual Clinical ... of the Utilization Management Supervisor, the Behavioral Health (BH) Utilization Management (UM) Clinician is responsible for conducting benefit coverage… more