• Utilization Review Clinician…

    Centene Corporation (Salem, OR)
    …and substance abuse preferred. **Knowledge of mental health and substance abuse utilization review process preferred.** Experience working with providers and ... appropriateness in accordance with regulatory guidelines and criteria + Performs concurrent review of behavioral health (BH) inpatient to determine overall… more
    Centene Corporation (12/25/25)
    - Related Jobs

  • Payment Integrity Clinician

    Highmark Health (Salem, OR)
    …of the claim rejection and the proper action to complete the retrospective claim review with the goal of proper and timely payment to provider and member ... Payment Integrity strategies on a pre-payment and retrospective claims review basis. Review process includes a ...data to assure appropriate level of payment and resource utilization . It is also used to identify issues which… more
    Highmark Health (11/14/25)
    - Related Jobs