- Henry Ford Health System (Warren, MI)
- The support specialist is a support role crucial to the centralized Utilization Review team for time sensitive authorization tracking and resolution process. ... Responsible for obtaining and tracking approvals, denials, and additional information requests received from third party payers within the EMR. EDUCATION AND EXPERIENCE: + High School Diploma/GED + Working knowledge of computers and software systems… more
- Tufts Medicine (Burlington, MA)
- …**Job Overview** The position provides day to day support and oversight to Utilization Review departments and UM vendor management. The UM Operations Manager ... is responsible for compliance with CMS Conditions of Participation regarding Utilization Review and Discharge Planning including implementation and annual … more
- Centene Corporation (Jefferson City, MO)
- …members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various related functions ... complex and often conflicting requirements. + Oversee the operations of utilization management, reconciliation coordination, concurrent review (telephonic and… more
- CVS Health (Phoenix, AZ)
- …solutions that promote high-quality healthcare for members. We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. **Key ... times may vary based on business needs) **Location:** 100% Remote (US only) American Health Holding, Inc. (AHH), a...intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- Actalent (Sunrise, FL)
- …+ Prepare and present reports on department activities as assigned. Essential Skills + Clinical review + Utilization review + Utilization management + ... or LPN License. + Minimum of one year of utilization review experience and discharge planning in...involving shadowing a team member on-site on Tuesdays and remote shadowing via Teams. Pay and Benefits The pay… more
- Penn Medicine (Lancaster, PA)
- …day. Are you living your life's work? Summary: + Position Summary: The Utilization Management Specialist - Denials is responsible for evaluating medical records to ... without reasonable accommodation to perform the following duties: + Complete chart review and communicate patient status medical needs with insurance companies in… more
- Integra Partners (Troy, MI)
- Position Summary + Integra Partners is seeking a full-time Utilization Review Medical Director to support our Utilization Management team. This is a ... responsibility. The role requires daily participation in a structured authorization review queue and close adherence to workflow timelines and productivity… more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The Utilization review ... tech essentially works to coordinate the utilization review and appeals process as part of the denial...an SME to support the UR tech team and remote counter parts with the specific processes as applicable.… more
- Ascension Health (Appleton, WI)
- …salary range at the time of the offer._ **Responsibilities** Manage effective utilization review processes, including management of patient statusing processes ... Shift + **Hospital:** Columbia St Mary's + **Location:** Partially Remote and Appleton, WI **Benefits** Paid time off (PTO)...review programs and key performance indicators for all utilization review activities. + Interact with medical,… more
- Commonwealth Care Alliance (Boston, MA)
- …CCA-Auth & Utilization Mgmt **Position Summary:** The Sr Clinician, Behavioral Health Utilization Review will review behavioral health and substance use ... in behavioral health managed care preferred + Experience in behavioral health utilization review or medical necessity evaluation preferred **Required Knowledge,… more