- Actalent (Atlanta, GA)
- Job Title: Utilization Review - FULLY REMOTE Job Description This role involves performing precertification and medical necessity reviews for designated ... + Experience with MCG or Interqual is preferred. + Utilization review experience is a plus. Work...or Sick Leave) Workplace Type This is a fully remote position. Application Deadline This position is anticipated to… more
- Martin's Point Health Care (Portland, ME)
- …has been certified as a "Great Place to Work" since 2015. Position Summary The Utilization Review Nurse works as is responsible for ensuring the receipt of high ... for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use appropriate governmental policies as well as specified… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Part- time and will work 8-hour, Day ... Schedule:** Part time **Job Shift:** Day **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi St… more
- Providence (Mission Hills, CA)
- **Description** **RN Utilization Review at Providence Holy Cross Medical Center in Mission Hills, CA. This position is Full- time and will work 8-hour, Day ... time **Job Shift:** Multiple shifts available **Career Track:** Nursing **Department:** 7000 UTILIZATION MGMT REMOTE **Address:** CA Mission Hills 15031 Rinaldi… more
- Henry Ford Health System (Warren, MI)
- …Under minimal supervision, reviews and screens the appropriateness of services, the utilization of hospital resources and the quality of patient care rendered. ... Science Nursing required OR four (4) years Case Management/ Appeal/ Utilization Management experience in lieu of bachelor's degree. CERTIFICATIONS/LICENSURES… more
- Spectrum Billing Solutions (Skokie, IL)
- …in the most efficient and streamlined manner. We are seeking to add an ABA Utilization Review (UR) Specialist to our growing team. The ABA UR Specialist will ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- CVS Health (Phoenix, AZ)
- …promote high-quality healthcare for members. **Position Summary** We are seeking a dedicated Utilization Management (UM) Nurse to join our remote team. In this ... times may vary based on business needs) Location: 100% Remote (US only) **About Us** American Health Holding, Inc....intensive outpatient programs. + At least 1 year of Utilization Management experience in concurrent review or… more
- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management, the Utilization Review Specialist will perform prospective, ... benefit coverage. Leveraging clinical expertise and critical thinking skills, the Utilization Review Specialist, will analyze clinical information, contracts,… more
- Centene Corporation (Springfield, IL)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... central or eastern time zone with experience in mental health settings and utilization management / review .** Department: PHCO BH UM supporting IL Meridian… more
- Cognizant (Annapolis, MD)
- **Schedule:** Monday to Friday - Eastern Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced level work ... as well as timely filing deadlines and processes. . Review clinical denials including but not limited to referral,...Based on this role's business requirements, this is a remote position open to qualified applicants in United States.… more
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