- 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 ... admission and clinical information to ensure medical necessity and compliance of utilization review guidelines. + Obtain initial and continuing authorization for… more
- Centene Corporation (Jefferson City, MO)
- … utilization management team. + Monitors behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines + Monitors ... on workplace flexibility. **Position Purpose:** Supervises the behavioral health (BH) utilization review clinicians to ensure appropriate care for members… more
- AmeriHealth Caritas (Dover, DE)
- …the direction of a supervisor , the Clinical Care Reviewer - Utilization Management evaluates medical necessity for inpatient and outpatient services, ... in a fast-paced environment. ;The Clinical Care Reviewer - Utilization Management will also be counted upon...document and assess patient cases. + Strong understanding of utilization review processes, including medical necessity criteria,… more
- Amity Foundation (Tucson, AZ)
- …building. Remembrance, Resolution, Reconciliation, Restoration, Renewal Job Summary: As the Utilization Review Specialist, you will contribute to the ... individual is responsible for performing a variety of concurrent and retrospective utilization management -related reviews and functions and for ensuring that… more
- St Joseph's Addiction Treatment & Recovery Centers (Saranac Lake, NY)
- …Centers Location: Inpatient Facility - Saranac Lake, NY Position: Full-time Utilization Review Specialist Shift/schedule: Monday-Friday, 8:00am-4:30pm Pay Range: ... , supporting the agency's mission and client care quality. Department Utilization Review Employment Type Full-Time Minimum Experience Mid-level Compensation… more
- Excellus BlueCross BlueShield (Utica, NY)
- …depending on customer and departmental needs. + Plans, implements, and documents utilization management activities which incorporate a thorough understanding of ... productivity and gain efficiencies for performance improvement opportunities in the Utilization Management Department. + Assists in updating departmental… more
- Stanford Health Care (Palo Alto, CA)
- …- 5+ years of experience as an RN - 3+ years of experience in case management / utilization review Why work at Stanford Medicine | Stanford Health Care (SHC)? ... on a rotating basis with other managers when on-call Supervisor is unavailable. + Develops and oversees relationships and...+ Knowledge of principles and best practices of case management , utilization review , social work,… more
- Catholic Health Services (Melville, NY)
- …ensure timely follow through. | Reviews providers' requests for services and coordinates utilization /appeals management review . | Assist Utilization and ... Utilization and Appeals Coordinator will perform activities to help facilitate utilization management and appeals functions to include coordination of… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …encourage you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and ... and Appeals requests. + Assist with all Blue Card Claims escalations. + Assist management with the review and creation of desk level procedures, acting as… more
- AmeriHealth Caritas (Charleston, SC)
- …about us at www.amerihealthcaritas.com . **Responsibilities:** Under the direction of the Supervisor , the Behavioral Health Utilization Management Reviewer ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer's discretion...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care… more
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