- Intermountain Health (Las Vegas, NV)
- …appeals levels 1-3 are a must in order to be considered for the position.** Performs medical review activities pertaining to utilization review , claims ... care management, claims, network management, and finance. As the Medical Director for Utilization Management, you are...review , quality assurance, and medical review of complex, controversial, or experimental medical … more
- AnMed Health (Anderson, SC)
- The Utilization Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- Alameda Health System (Oakland, CA)
- …knowledge of current trends and changes in healthcare delivery as it pertains to utilization review (eg, medical necessity, level of care) by participating ... System Utilization Management SUM Utilization Review...Expeditiously refer cases to the internal/external Physician Advisor for review of requests that may not meet medical… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Catholic Health Initiatives (Omaha, NE)
- …for our patients. **This position offers the flexibility to work remotely with proven Utilization Review experience.** Medical Coding experience is a plus! ... **Responsibilities** Are you a skilled and experienced Utilization Review Specialist looking for a...you will be responsible for conducting comprehensive reviews of medical records using evidence-based guidelines and critical thinking to… more
- Spectrum Billing Solutions (Skokie, IL)
- …and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for ... for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing...+ Demonstrate the ability to make critical decisions about medical necessity of treatment by using good judgment. +… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …II (in addition to Level I Qualifications) + Minimum 2-3 years of experience in medical management, utilization review and case management. + Knowledge of ... recommendations and/or decisions on Utilization or Case Management activities. Utilization review activities include: reviews of requests for broad range… more
- The Cigna Group (Bloomfield, CT)
- …Must be able to research clinical issues on internet resources. - Experience in medical management, utilization review and case management in a managed ... medical research to ensure the quality of the medical care provided to patients. Implements utilization ...center. Requires an MD, DO or DC. SUMMARY: The Medical Director performs medical review … more
- Beth Israel Lahey Health (Burlington, MA)
- …a difference in people's lives.** Joint role of Case Manager and Utilization Review Nurse Onsite at Lahey Hospital and Medical Center in Burlington Hospital ... hospital staffs. -Case Manager experience as well as Utilization Review experience ( review medical necessity and discharge planning) **As a health care… more
- Adecco US, Inc. (Houston, TX)
- …to 5pm **Pay:** $85,00 to $110,000 yearly **Responsibilities of the Utilization Review Nurse:** . ** Review Medical Records:** Thoroughly evaluate patient ... & Life Sciences is assisting a client hire a Utilization Review Nurse in Houston, TX! This...of treatments and services. . **Conduct Audits:** Regularly audit medical records and healthcare practices to ensure compliance with… more
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