- Actalent (Orlando, FL)
- …systems + Work with providers to approve or recommend determinations based on review findings + Educate providers on utilization processes to ensure high-quality ... Clinical Review Nurse - Concurrent Review Location:...preferred) + Knowledge of Medicaid or Medicare regulations and utilization management processes + Proficiency in Microsoft Word, Excel,… more
- Molina Healthcare (Yonkers, NY)
- …or emergency room. Preferred Experience Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- Centene Corporation (Denver, CO)
- …to identify and implement opportunities for improvement. + Oversees the clinical review of outcomes including creating and editing correspondence letters with the ... and NCQA standards + Provides expert insight and guidance on the clinical review process of correspondence to ensure compliance with all applicable State and Federal… more
- Molina Healthcare (North Las Vegas, NV)
- …care unit (ICU) or emergency room. Previous experience in managed care Prior Auth, Utilization Review / Utilization Management and knowledge of Interqual / ... JOB DESCRIPTION Job Summary Provides support for clinical member services review assessment processes. Responsible for verifying that services are medically… more
- SUNY Upstate Medical University (Syracuse, NY)
- …including PC, Windows, Microsoft applications, Zoom/WebEx platforms, etc. Preferred Qualifications: Utilization management or utilization review experience, ... with reimbursement entities. This is achieved through a thorough chart review and utilization of first-level screening criteria to ensure patients are at the… more
- Molina Healthcare (NM)
- **JOB DESCRIPTION** Opportunity for experienced Utilization Review RN (preferred) or LPN with a compact license who resides in New Mexico or Texas. This team ... field, such as social work or clinical counselor (for Behavioral Health Care Review Clinicians only). **Required Experience** 1-3 years of hospital or medical clinic… more
- The Cigna Group (Bloomfield, CT)
- …in CMS' Preclusion List** **Preferred Skill Sets:** + Experience in medical management, utilization review and case management in a managed care setting. + ... Cigna. **Summary description of position** : A Medical Principal performs medical review and case management activities. The physician provides clinical insight to… 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' ... Compensation Nurse Case Reviewer collaborates with medical care providers, employers, employees, and...for timely return to work. + Provides case management, utilization review , continued stay reviews, and based… more
- Elevance Health (Indianapolis, IN)
- **Genetic Counselor Review Associate** **Genetic Testing Utilization Review ** **Carelon Medical Benefits Management** **Virtual** : This role enables ... domains, including radiology, cardiology and oncology._ The **Genetic Counselor Review Associate** is responsible for authorization requests and determining their… more
- Penn Medicine (Plainsboro, NJ)
- …to all relevant parties, including but not limited to patient, family, Utilization Reviewer , and outpatient treatment providers. + 3. Provides specialized ... + Communicates effectively the essential clinical features of each case with utilization reviewers and monitors patient attendance in scheduled program and length of… more