- Excellus BlueCross BlueShield (Rochester, 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
- Magellan Health Services (Baton Rouge, LA)
- … management and verbal and written communication skills. Knowledge of utilization management procedures, Medicaid benefits, community resources and providers. ... care setting. Also requires minimum of 4 years of experience conducting utilization management according to medical necessity criteria. General Job Information… more
- ChenMed (Miami, FL)
- …The Physician Reviewer is the primary physician reviewer for Utilization Management /Clinical Appropriateness review cases in our organization. Other ... Process and Quality improvement in our developing area of Delegated Utilization Management . **ESSENTIAL JOB DUTIES/RESPONSIBILITIES:** + Provides Delegated… more
- Healthfirst (NY)
- …Medical Peer Reviewer will: + Maintain productivity standards. + Collaborate with Utilization Management and Care Management and medical departments as ... **Duties//Responsibilities:** + The Medical Peer Reviewer will assess// review requests for authorization,...Medicine or Family Practice + Previous, relevant experience in utilization management and clinical practice + Knowledge… more
- Elevance Health (Norfolk, VA)
- …Health Care Management staff by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists in ... **Psychologist Reviewer ** **Hybrid 1:** This role requires associates to...adaptable workplace. **The successful candidate must be a licensed psychologist in North Carolina and will preferably live… more
- Trinity Health (Hartford, CT)
- …**Minimum five years' experience in quality improvement, data collection and analysis or utilization management in a hospital setting required** + Current RN ... minimum 5 years in a hospital setting **Position Purpose** The Patient Quality Reviewer is an experienced expert in the area of Regulatory Quality and Performance… more
- US Tech Solutions (Columbia, SC)
- …+ Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits ... any of the following in support of medical claims review and utilization review practices:...- Nursing OR Graduate of an Accredited School of Licensed Practical Nursing or Licensed Vocational Nursing… more
- AmeriHealth Caritas (LA)
- **Role Overview:** Under the direction of the Supervisor, the Behavioral Health Utilization Management (BHUM) Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...and American Society of Addiction Medicine (ASAM) criterion + Utilization management experience within a managed care… more
- Houston Methodist (Houston, TX)
- …+ Five years of hospital clinical nursing experience, which includes three years in utilization review and/or case management **LICENSES AND CERTIFICATIONS - ... At Houston Methodist, the Utilization Review Specialist Nurse (URSN) position...to physicians, nurses, and other health care providers on utilization management topics. + Initiates improvement of… more
- TEKsystems (Canoga Park, CA)
- … Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims ... JobTitle: Retro Claims Reviewer Location: West Hills/Canoga Park 91304 Compensation: LVN...RN license (California) + 2+ years of experience in Utilization Management (UM) + Hands-on experience with… more
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