- Blue Shield of California (El Dorado Hills, CA)
- …readiness in collaboration with internal BSC partners Perform advanced or complicated prior authorization and concurrent utilization reviews and first level ... Job Description Your Role The Behavioral Health (BH) Utilization Management (UM) team performs prospective, concurrent, retrospective utilization reviews and… more
- Ascension (Wichita, KS)
- …nursing OR Required professional licensure at time of hire. Additional Preferences Prior experience in case management or utilization review strongly preferred. ... Details Department: Utilization Management Schedule: Full-time, Day Shift, 40 hours/week,...Nurse credentialed from the Kansas Board of Nursing obtained prior to hire date or job transfer date. Education:… more
- UnitedHealth Group (Phoenix, AZ)
- …to the CMO and leadership team. They will support the CMO with utilization management (UM), prior authorization determinations, oversight and direction of ... inpatient and skilled nursing facility utilization , oversight and direction of Outpatient Care Management Services, Medicare Risk Adjustment Factor (RAF) education… more
- Blue Shield of California (Oakland, CA)
- Job Description Your Role The Behavioral Health Utilization Management team performs prospective & concurrent utilization reviews and first level determinations ... clinal criteria across multiple lines of business. The Behavioral Health Utilization Management Clinician, Experienced, will report to the Manager of Behavioral… more
- Network Health WI (Menasha, WI)
- The RN Coordinator Utilization Management reviews submitted authorization requests for medical necessity, appropriateness of care, and benefit eligibility. The RN ... Coordinator Utilization Management reviews applicable guidelines regarding payment and coverage, and makes determinations for authorization/payment. Location:… more
- American Traveler (Roseville, CA)
- …information, including any BG hits or DUIs, must be disclosed prior to consideration, Additional Information *Responsible for comprehensive case management, ... utilization review, and coordination of care within an integrated...*Must have a broad knowledge base of healthcare delivery, utilization review, observation status, and post-acute levels of care,… more
- Morgan Stephens (Phoenix, AZ)
- Job Title: Physical Therapist (PT) - Utilization Management Organization: Managed Care Organization Must be licensed in Arizona Pay: Up to: $72.00 per hour Position ... Organization is seeking a qualified Physical Therapist (PT) to join our Utilization Management Team. This position will primarily involve conducting chart reviews to… more
- Actalent (Oklahoma City, OK)
- …In this role, you will utilize your clinical skills to conduct utilization management reviews, including prior authorizations, coverage exceptions, and quantity ... contracts evaluated every six months for extension. Responsibilities Conduct utilization management reviews, including prior authorizations, coverage exceptions,… more
- KMA Human Resources Consulting (South Portland, ME)
- …direction for patients when their physicians are unavailable. Participates in utilization review and prior authorization requests. Supports programmatic ... development, particularly for complex lung disease. Chest Medicine Associates is a well-established, independent practice in South Portland, Maine. We have provided regional expertise in sleep medicine, pulmonology, medical and neurological critical care for… more
- Actalent (Kansas City, MO)
- …Your main role will be utilizing your clinical skills to complete utilization management reviews, including prior authorizations, coverage exceptions, and ... team of your peers and other pharmacy professionals. Responsibilities Conduct utilization management reviews independently. Participate in a team of pharmacy… more
