- Centene Corporation (Jefferson City, MO)
- …28 million members. **Position Purpose:** Oversee operations of the referral management, telephonic utilization review , prior authorization, and various ... the operations of utilization management, reconciliation coordination, concurrent review ( telephonic and on-site), specialty therapy programs and other… more
- ICW Group (Las Vegas, NV)
- …regulatory standards. + Interfaces with external agencies in relation to the utilization review process including, Third-Party Payers, Insurance Companies and ... evaluate needs for treatment in worker's compensation claims. The Telephonic Nurse Case Manager will negotiate and coordinate appropriate...Providers. + May perform Utilization Review activities (or review … more
- Access Dubuque (Dubuque, IA)
- …consumers, ensuring quality outcomes and cost-effective treatment. **Key Responsibilities:** + Provide telephonic case management and utilization review for ... + **Experience:** Minimum 2 years of clinical practice. Case management or utilization review experience strongly preferred. + **Skills:** Strong communication,… 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
- US Tech Solutions (Columbia, SC)
- …mental health/chemical dependency, orthopedic, general medicine/surgery. OR, 4 years utilization review /case management/clinical/or combination; 2 of 4 years ... have critical thinking skills. Experience in case management or care coordination and telephonic care experience is preferred. + A typical day would be managing a… more
- LA Care Health Plan (Los Angeles, CA)
- …determination. Actively monitors for admissions in any inpatient setting. Performs telephonic and/or onsite admission and concurrent review , and collaborates ... Utilization Management Nurse Specialist RN II Job Category:...and ensure a positive and productive workplace environment. Perform telephonic and/or onsite admission and concurrent review ,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …you to apply! Job Description: Summary: This position supports the Utilization Management (UM) workflows by providing administrative support and customer service. ... related care management units) to ensure end-to-end process for authorizations, telephonic notifications, and/or care management referrals is accurate and complete.… more
- Actalent (Tampa, FL)
- … review experience and/or discharge planning. + 2 years of utilization review /management experience. Additional Skills & Qualifications + Current and ... Actalent is hiring a Clinical Review Nurse role! Job Description The Clinical Reviewer...Nurse role! Job Description The Clinical Reviewer is a telephonic position responsible for recommending discharge plans, assisting with… more
- ChenMed (North Miami Beach, FL)
- …assess and record patients' progress and adjust and plan accordingly. + Understanding utilization review and how to leverage with inpatient staff for possible ... the above "Core" duties/responsibilities plus the following: + Provides telephonic or outpatient visits to patients at high-risk for...experience required. + A minimum of 1 year of utilization review and/or case management, home health,… more
- CommonSpirit Health (Houston, TX)
- …intricacies of ICD-9-CM, ICD-10-CM/PCS, MS-DRG, and APR-DRG. + Contacts Case and Utilization Management Teams: Makes telephonic /electronic contacts with case and ... position and you must be licensed in the state of Texas. As the Utilization Management Physician Advisor (PA), the PA conducts clinical case reviews referred by case… more
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