- Sanford Health (SD)
- …level of care medical necessity reviews within patient's medical records. Performs utilization management (UM) activities in accordance with UM plan to assure ... relating to determination of medical necessity, authorization, continued stay review including diagnosis and procedural coding for working diagnosis related… more
- Intermountain Health (Las Vegas, NV)
- …1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims review , quality ... with MG clinicians, Affiliate Network PCPs and Specialists in the community, utilization management, care management, claims, network management, and finance. As the… more
- University of Utah Health (Salt Lake City, UT)
- …as a team member. **Qualifications** **Qualifications** **Required** + **One year** ** Utilization Review or Case Management experience.** **Licenses Required** + ... patient and the organization through the provision of quality based patient care focusing on the medical necessity and...Criteria, knowledge of ICD-9, DRG's and CPT Codes. + Utilization Review Certification designation. + Knowledge of… more
- Catholic Health Initiatives (Omaha, NE)
- **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a rewarding opportunity to impact patient care and optimize ... position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is...through more than 2,300 clinics, care sites and 137 hospital- based locations, in addition to its home -… more
- Albany Medical Center (Albany, NY)
- …and documents findings based on Departmental standards.* While performing utilization review identifies areas for clinical documentation improvement and ... environment.* Basic knowledge of computer systems with skills applicable to utilization review process.* Excellent written and verbal communication skills.*… more
- Molina Healthcare (Owensboro, KY)
- …state they reside. We are looking for a RN Manager to manage a utilization management team supporting 14 Marketplace plans. Home office with internet ... performing one or more of the following activities: care review / utilization management (prior authorizations, inpatient/outpatient medical necessity, etc.),… more
- Sanford Health (ND)
- …- $28.00 **Department Details** Opportunity to work remote **Job Summary** Monitors the utilization of resources, risk management and quality of care for patients in ... hospitalization to ascertain medical necessity and appropriateness. Assists with retrospective review of specified charts as required. Ability to interact on an… more
- AmeriHealth Caritas (Dover, DE)
- …efficiently document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria, care coordination, ... + Demonstrated ability to meet productivity standards in a fast-paced, high-volume utilization review environment. + Availability to work Monday through Friday,… more
- Centene Corporation (Tallahassee, FL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... and have the flexibility to work remotely from their home . **Position Purpose:** Performs a clinical review ...Analyzes BH member data to improve quality and appropriate utilization of services + Provides education to providers members… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. Responsible for compliance ... with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation...and resource management into a singular effort to ensure, based on patient assessment, care is provided in the… more
Related Job Searches:
Based,
Home,
Home Based,
Review,
Review Home,
Utilization,
Utilization Review,
Utilization Review Home