- BrightSpring Health Services (Dunbar, WV)
- …and submit to State Health Services Director and Assigned Director, Clinical Practice* Review utilization report at least monthly to ensure adequate hours on ... meetings* Chairs committees as applicable (eg safety, infection control, incident/accident review , human rights, etc.).* Participates in the development of the… more
- US Tech Solutions (Columbia, SC)
- …3 years clinical experience or 2 years clinical experience plus 1 year utilization /medical review , quality assurance, or home health. **Skills:** + Working ... onsite for at least 1 month and if progressing well, can be moved to work remote . + Prefer 2 yrs. UM and/or appeals experience. + Experience with prior insurance, … more
- Saint Francis Health System (Tulsa, OK)
- …including COPD, pneumonia, CHF, PEC (pre-exiting conditions), and cardiac monitoring + Remote cardiac monitoring + Work closely as a team with case management, ... ER, ICU, and CTU units. + All private rooms Job Summary: The Registered Nurse I assesses, plans, implements and evaluates nursing care, utilizing the nursing process… more
- US Tech Solutions (GA)
- **Job Description:** This is a remote position and requires the ability to effectively support a work from home environment. Must have the ability to work in a HIPAA ... involve computer system data entry, data management, and reporting. + Review criteria-based prior authorizations following policy and procedure. + Provide on-call… more
- Tufts Medicine (Melrose, MA)
- …role is essential in developing and maintaining an infrastructure for the systematic review and management of complex patients. The position will work closely with ... managers, TMIN Practice Optimization Coaches (POMs) and primary care providers to review patient records, analyze data, and identify practice and patient outlier … more
- Actalent (New York, NY)
- …nursing experience. + Proficiency with Microsoft Office applications. + Experience with utilization or appeals review . + Knowledge of InterQual criteria. + ... determine if medical necessity criteria are met. Responsibilities + Review clinical data to determine claim payment based on...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Blue KC (MO)
- …and regularly attends client meetings (with benefits managers and executives) to review health outcomes and cost information. + Actively monitors care management ... special consideration (eg, benefits) should be made. + Participate in existing client utilization and renewal meetings or tell our clinical value story as requested.… more
- Providence (Lubbock, TX)
- …in a medical record. + 2 years - HEDIS, Quality management/quality improvement/ utilization review auditing experience, including experience in auditing within ... and Data Information Set (HEDIS) program + Conduct Audits inclusive of review of outpatient medical records, hospital records, clinical lab and pharmacy records… more
- CareFirst (Baltimore, MD)
- …related experience working in Care Management, Discharge Coordination, Home Health, Utilization Review , Disease Management or other direct patient care ... other members of the interdisciplinary care team to coordinate services, decrease utilization , and ensure optimal health outcomes. We are looking for an experienced… more
- Providence (Beaverton, OR)
- …of Care Planning, Discharge Planning, Coordination of Outpatient Care) + Utilization Management Experience (EX. Concurrent Review , Prior Authorization, Medical ... nearing end of life + Care management services include: nurse education, care coordination and general assistance with managing...care to our members **Providence Health Plan welcomes 100% remote work to residents who reside in the following… more