- Houston Methodist (Sugar Land, TX)
- At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and ... concurrent medical record review for medical ...this position is able to cover a multitude of utilization review functions through point of entry,… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- LifeCenter Northwest (Bellevue, WA)
- Organ Utilization Coordinator Job Details Job Location Bellevue HQ - Bellevue, WA Position Type Full Time Salary Range $75918.00 - $110112.00 Salary Job Posting ... Date(s) Start Date 08/05/2025 Description and Qualifications The Organ Utilization Coordinator (OUC) is accountable for overseeing all activities related to the… more
- Commonwealth Care Alliance (Boston, MA)
- …for day-to-day timely clinical and service authorization review for medical necessity and decision-making. The Utilization Management Reviewer has a ... to the Utilization Management Manager. * Conducts timely clinical decision review for services requiring prior authorization in a variety of clinical areas,… more
- CareFirst (Baltimore, MD)
- …required work experience. **Experience:** 5 years Experience in a clinical and utilization review roles. 1 year demonstrated progressive leadership experience. ... **Resp & Qualifications** **PURPOSE:** Manages the utilization of referral services. Enhances quality of care...**Knowledge, Skills and Abilities (KSAs)** + Proficient in standard medical practices and insurance benefit structures. + Proficient in… more
- CVS Health (Columbus, OH)
- …and trainings to New Albany Office in OH. **Preferred Qualifications** + Managed care/ utilization review experience preferred + Experience in a behavioral health ... Summary** The Behavioral Health UM Clinician position is designed to clinically review of behavioral health prior authorized services for assigned members. This… more
- Humana (Boise, ID)
- …conducting comprehensive reviews of medication care plans. This includes evaluating medical necessity, analyzing overall utilization , and identifying unusual ... Qualifications:** + Experience in managed care pharmacy, particularly in utilization management review **Additional Information:** **Interview Format**… more
- Guidehouse (New York, NY)
- …based on physician certification + Gathers clinical information to conduct continued stay utilization review activities with payers on a daily basis + Performs ... **Job Family** **:** Clinical Appeals Nurse ** Travel Required** **:** None **Clearance Required** **:** None...None **What You Will Do** **:** + Performs chart review of identified patients to identify quality, timeliness and… more
- CenterWell (Augusta, ME)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... Prior clinical experience, managed care experience, DME, Florida Medicaid **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to… more
- CenterWell (Denver, CO)
- …will collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines/NCQA review ... RN experience; + Prior clinical experience, managed care experience, **OR** utilization management experience + Demonstrates Emotional Maturity + Ability to work… more
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