- AmeriHealth Caritas (Washington, DC)
- …BONUS** **Role Overview:** Under the direction of a supervisor, the Clinical Care Reviewer - Utilization Management evaluates medical necessity for ... on clinical criteria. Using professional judgment, the Clinical Care Reviewer assesses the...patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care … more
- Community Health Systems (Franklin, TN)
- …collaborates with healthcare providers to facilitate efficient patient care . The Clinical Utilization Review Specialist monitors adherence to hospital ... **Job Summary** The Clinical Utilization Review Specialist...of clinical experience in utilization review , case management, or acute care nursing… more
- Cedars-Sinai (Los Angeles, CA)
- …CDIP OR CPC, required Experience: A minimum of 5 years of experience in Acute Clinical Care , Utilization Review , Coding, or Case Management required ... World Report has named us one of America's Best Hospitals. As our next Clinical Documentation Specialist, you will work under the general direction of the HID… more
- UPMC (Pittsburgh, PA)
- …. Through the CMA's collaborations, practical comprehension and hands-on experience in clinical care / utilization management will result by collecting and ... Services Team at UPMC Health Plan to facilitate effective care plans that achieve optimal satisfaction, and clinical...and 2 weeks PTO your first year Responsibilities + Review Health Plan data for services the member has… more
- Commonwealth Care Alliance (Boston, MA)
- 013650 CCA-Auth & Utilization Mgmt Position Summary: Commonwealth Care Alliance's (CCA) Clinical Effectiveness (Authorization) Unit is primarily responsible ... CCA's benefits plan. The Utilization Management (UM) Reviewer is responsible for day-to-day timely clinical ...(UM) Reviewer is responsible for day-to-day timely clinical and service authorization review for medical… more
- AmeriHealth Caritas (Lafayette, LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...and American Society of Addiction Medicine (ASAM) criterion. + Utilization management experience within a managed care … more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …to provide the best quality care . The Team The commercial Physical Therapy Utilization Management Reviewer is part of a highly dedicated and motivated team ... true colors to blue. The Role The Physical Therapy Utilization Management Reviewer is responsible for evaluating...with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of… more
- Guthrie (Troy, PA)
- …$15,000.00 Sign on Bonus! Summary The LPN Utilization Management (UM) Reviewer , in collaboration with Care Coordination, Guthrie Clinic offices, other ... aggregation associated with UM processes and operations. Experience Minimum of five years clinical experience in an acute health care setting. Must possess… more
- CenterWell (Denver, CO)
- … clinical RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity ... and proposed medical care and services against established CMS Coverage Guidelines/NCQA review criteria and who is interested in being part of a team that… more
- CVS Health (Columbus, OH)
- …+ Independent clinical license preferred: LPCC, IMFT, or LISW + Managed care / utilization review experience + Case management and discharge planning ... with heart, each and every day. **Position Summary** The Care Plan Reviewer ( Clinical Case...systems. Assessment of Members: + Through the use of clinical tools and information/data review , conducts comprehensive… more