- Sacramento Behavioral Healthcare Hospital (Santa Rosa, CA)
- …mental health and co-occurring psychiatric and substance abuse conditions. POSITION TITLE: Utilization Review Clinician PAY RANGE: LVN/LPT $35.00-44.19 Per ... and optimize reimbursement for external reviewers/third party payers. The Utilization Review Clinician maintains knowledge...ensure that extended stays are medically justified. + Payment Appeals : Prepare and submit appeals to third… more
- Humana (St. Paul, MN)
- …Office products including Word, Excel and Outlook **Preferred Qualifications** + Utilization Review /Quality Management experience + Experience working with MCG ... **Become a part of our caring community and help us put health first** The Appeals Nurse 2 resolves clinical complaints and appeals . The Appeals Nurse 2 work… more
- City and County of San Francisco (San Francisco, CA)
- …and + May perform Quality Improvement activities such as chart audit and compliance review . + The 2932 Senior Behavioral Health Clinician performs related duties ... Francisco continuously accepts applications for all permanent Senior Behavioral Health Clinician 2932 positions. Rather than publishing separate job ads for every… more
- City and County of San Francisco (San Francisco, CA)
- …of San Francisco continuously accepts applications for all permanent Behavioral Health Clinician 2930 positions. Rather than publishing separate job ads for every ... Homelessness and Supportive Housing and the Department of Public Health can then review your application and contact you directly with details about their positions.… more
- Molina Healthcare (Orem, UT)
- …(Team will work on set schedule) Looking for a RN with experience with appeals , claims review , and medical coding. JOB DESCRIPTION Job SummaryProvides support ... for clinical member services review assessment processes. Responsible for verifying that services are...to promote the Molina care model. * Adheres to utilization management (UM) policies and procedures. Required Qualifications *… more
- UPMC (Pittsburgh, PA)
- …of medical management best practices. + Actively participates in the utilization management and quality improvement review processes, including concurrent, ... the Quadruple Aim of better health, better care, lower costs, and higher clinician satisfaction. The role is primarily working with health plan Medicare (including… more
- Blue Cross and Blue Shield of Minnesota (Eagan, MN)
- …across the continuum of care by leveraging member partnership, pre-service clinical utilization review , case and disease management processes, skill sets and ... a critical component of BCBSMN Medical Management team as the primary clinician providing condition and case management services to members. Your Responsibilities *… more
- Blue Cross Blue Shield of Massachusetts (Boston, MA)
- …credentialed provider + Active clinical practice in order to participate in panel appeals + Experience in Utilization Management in a managed-care environment ... At the request of the Associate Medical Director of the Physician Psychologist Review Unit, the Reviewer also provides clinical leadership in other areas of BCBSMA.… more
- Elevance Health (Indianapolis, IN)
- …must be located in a state or territory of the United States when conducting utilization review or an appeals consideration and cannot be located on ... required by law. The **Plan Performance Medical Director** serves as a lead clinician and oversees the administration of medical services for the individual ACA… more
- Whitney Young Health Center (Albany, NY)
- …to continually assess and improve the quality of patient services-conducts monthly utilization review . + Participates in the recruitment of clinical staff. ... to increase patient access to care, enhance program census, and achieve clinician productivity standards. + Leads and engages clinicians in direct services and… more