- CVS Health (Tallahassee, FL)
- …it all with heart, each and every day. **Position Summary** This is a fulltime remote Utilization Review opportunity. Working hours are four 10hr days ... UMNC participating in non-traditional, weekend shift rotation **Preferred Qualifications** + Utilization review experience + Experience with LTAC, skilled rehab,… more
- Prime Healthcare (Garden Grove, CA)
- …with health information management staff, coding staff, physicians, financial services, onsite and remote utilization review teams with regards to admission ... both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Works...Health and Human Services field is highly preferred. 2. Utilization Review /Case Management experience is highly preferred.… more
- Chesapeake Regional Healthcare (Chesapeake, VA)
- * Remote in Hampton Roads* Summary The Utilization Review Nurse combines clinical expertise with knowledge of medical appropriateness criteria, and applies ... a facilitator and consultant to the multidisciplinary patient care team. The Utilization Review Nurse is responsible for review of clinical information… more
- AdventHealth (Altamonte Springs, FL)
- …reviews within 24 hours of admission; and when warranted by length of stay, utilization review plan, and/or best practice guidelines, on a continuing basis. 2) ... better. **Shift** : Full-time; Monday -Friday **Job Location** : Remote **The role you will contribute:** The role of...**The role you will contribute:** The role of the Utilization Management (UM) Registered Nurse (RN) is to use… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Supervisor to our growing team. The UR Supervisor ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Elevance Health (Woodbridge, VA)
- RN Utilization Review Nurse (Washington DC Medicaid) JR149756 **Location** : This role requires associates to be in-office 4 days per week, Monday - Thursday, ... approach combines structured office engagement with the autonomy of remote work, promoting a dynamic and adaptable workplace. The...experience and requires a minimum of 2 years clinical, utilization review , or managed care experience; or… 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 (Jefferson City, MO)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... including a fresh perspective on workplace flexibility. POSITION IS REMOTE BUT CANDIDATE MUST RESIDE IN MISSOURI AND HOLD...YEAR WITH THIS ROLE **Position Purpose:** Performs a clinical review and assesses care related to mental health and… more
- Spectrum Billing Solutions (Skokie, IL)
- …revenue cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more