- Commonwealth Care Alliance (Boston, MA)
- … Director of Medical Policy and Utilization Review , the Utilization Review Medical Director will be responsible for providing leadership and ... growing membership. The incumbent will have significant experience with utilization review , ideally experience with public programming,...Serve as the lead for CCA's Utilization Review functions working closely with other medical … more
- Prime Healthcare (Ontario, CA)
- …Responsibilities The position of Senior Utilization Review Manager is ... responsible for the oversight of third-party payer utilization review (UR), denial management (DM) processes in addition to the additional special projects.… more
- Houston Methodist (Houston, TX)
- At Houston Methodist, the Utilization Review Nurse (URN) position is a licensed registered nurse (RN) who comprehensively conducts point of entry and concurrent ... medical record review for medical ...work experience in a hospital or insurance company providing utilization review services + Knowledge of Medicare,… more
- Scottish Rite for Children (Dallas, TX)
- …giving children back their childhood! Job Posting Title: Case Manager and Utilization Review Coordinator Location: Dallas - Hospital Additional Posting Details: ... effective communication with patient care team members related to utilization management + Verify medical necessity of...and other areas as assigned + Serve on the Utilization Review Committee for the Scottish +… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …and leadership programs + And more! **Description** The **Registry Utilization Review Nurse** (PRN) is responsible for conducting medical necessity reviews ... physician advisor. + The UR RN (PRN) will perform utilization review by completing a timely and...Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board. +… more
- Aspen Medical (Aurora, CO)
- …and Management (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP), Certified Informatics Nursing, Ambulatory Care ... for Registered Nurses to partner with us in providing temporary contracted medical services to Military Treatment...in a direct patient care clinical setting. Must have utilization management, utilization review or… more
- Prime Healthcare (Riverdale, GA)
- …of Utilization Management will provide leadership and oversight to the utilization review and clinical appeals process. The Director of Utilization ... Administration, HIM, Coding, ROI, Business Office, Financial Services and CMO for utilization Review . The Executive Director is responsible for education of… more
- Prime Healthcare (Inglewood, CA)
- …to case managers, social workers and case management coordinators/discharge planners, utilization review coordinators and utilization technicians. ... credentials and licensure. Connect With Us! (https://careers-primehealthcare.icims.com/jobs/209416/director-of-case-management utilization -management/job?mode=apply&apply=yes&in\_iframe=1&hashed=-336024306) FacilityCentinela Hospital Medical Center… more
- Actalent (Des Moines, IA)
- …specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following: * Medical , dental & vision * ... Utilization Management Nurse Job Description This role involves...timely prior approval for services and procedures, obtaining necessary medical information to make clinical determinations based on … more
- Veterans Affairs, Veterans Health Administration (Hines, IL)
- Summary The Utilization Management (UM) Consultant is a registered professional nurse, qualified by education and experience to work directly with physicians, ... The main objective of the role is to complete concurrent reviews of medical records and prepare clinical appeals (when appropriate) on medical necessity,… more