Medical Necessity Audit Specialist Utilization Management
$62.7k - $100.4kSanta Barbara Cottage Hospital
Santa Barbara Cottage Hospital is seeking a Clinical Audit Specialist - Utilization Management to conduct audits ensuring compliance with medical necessity criteria. This role requires expertise in evaluating utilization management decisions across health services. The ideal candidate will have an A.S in Nursing with a strong understanding of clinical criteria and must hold a valid RN license. The compensation range is $62,700 - $100,400, based on experience and performance. #J-18808-Ljbffr
$200k - $325k
...Relationship Manager The U.S. Bank Power & Utilities Division is looking for an experienced Relationship Manager to provide corporate coverage to a... ...Our benefits include the following: ~ Healthcare (medical, dental, vision) ~ Basic term and optional term life...MedicalTemporary workLocal area3 days per week- A VA Auth/Referral and Auditing Specialist is responsible for verifying patient... ...prior authorizations for medical services from insurance... ...to care for patients while managing the financial aspects of their... ...precertification necessity. Communicates and coordinates...Medical
$35 - $45 per hour
...healthcare data solutions provider is looking for an Inpatient Auditing Specialist to conduct coding audits and provide coder education. This... ...and comprehensive benefits for full-time employees, including medical and professional development stipends. #J-18808-Ljbffr...MedicalHourly payFull timeRemote workFlexible hours- ...Evolent is seeking an FMD in Radiology to play a crucial role within the utilization management team. The position involves reviewing imaging cases, ensuring compliance with medical necessity guidelines, and providing clinical rationale during peer-to-peer discussions...Medical
$124k - $335k
...Industry/Sector Asset and Wealth Management Specialism Industry Tax Practice Management... ...estate tax services * Building and utilizing networks of client relationships * Managing... ...a wide range of benefits, including medical, dental, vision, 401k, holiday pay, vacation...MedicalH1bLocal areaOverseas- ...A healthcare staffing agency is seeking a Utilization Management RN to work remotely from PA, DE, or NJ. The role involves assessing clinical information, determining medical necessity for services, and collaborating with providers. Candidates should have at least three...MedicalRemote workFlexible hoursWeekend workDay shift
$150 - $165 per hour
...healthcare consulting firm is seeking a Medical Director for a four-month engagement... ...role will provide clinical leadership in utilization management and oversee appeals related to... ...Responsibilities include monitoring medical necessity and rendering denial decisions. Ideal...MedicalHourly payContract work- ...for a healthcare organization. The role involves reviewing medical necessity determinations and applying InterQual criteria.... ...position offers a collaborative environment with opportunities to leverage clinical expertise in utilization management. #J-18808-Ljbffr...MedicalRemote work
- ...Senior Auditor participates in the audit, analysis, and testing of IT... ..., Audit Supervisor, or Audit Manager. Examples of Work Performed... ...policies, and procedures Ability to utilize problem‑solving techniques... ...to complete a post‑job offer medical history questionnaire and/or undergo...MedicalLocal areaMonday to Friday
- ...A healthcare staffing agency seeks a Utilization Management RN to evaluate clinical conditions through medical record reviews. The position is remote, requiring candidates... ...duties involve applying criteria for medical necessity, collaborating with providers, and managing...MedicalRemote work
$35 - $45.94 per hour
...Oscar Health is looking for a Utilization Review Nurse to join their team. The role involves performing medical necessity reviews and working with care providers to ensure quality patient care. Candidates must hold an active RN license and have at least one year of experience...MedicalHourly payRemote work$34.98 - $42.85 per hour
...ensuring compliance with regulatory requirements, documenting medical necessity, and communicating decisions effectively. Candidates must... ...of three years of clinical experience, preferably in utilization management. This remote position offers a wage range of $34.98 to $4...MedicalHourly payRemote work- ...Clover Health is seeking a Remote Utilization Management Registered Nurse (RN) to support members throughout their care journey. This role involves performing medical necessity reviews, applying CMS guidelines, and collaborating with providers to ensure high-quality care...MedicalRemote work
$86.61k - $108.07k
Healthfirst is seeking an Internal Audit Analyst in New York, NY. The role involves evaluating and maintaining internal controls for finance... ...2 - $108,074. Healthfirst offers a comprehensive benefits package including medical and 401k contributions. #J-18808-Ljbffr HealthfirstMedical- ...Medix™ is looking for experienced Utilization Management Medical Directors for a remote contract opportunity. This role is ideal for physicians... ...focus on conducting utilization reviews, managing medical necessity, and collaborating with clinical teams. Strong candidates...MedicalFull timeContract workRemote workFlexible hours
- ...Remote Physician Reviewer – Utilization Management ****This Person Needs to sit in PA, NJ, or Delaware**** IntePros is seeking a Physician... ...remote capacity. This role is responsible for reviewing medical necessity determinations, applying InterQual criteria, and collaborating...MedicalRemote work
$99k - $252.45k
...to 40% At PwC, our people in audit and assurance focus on... ...assessing governance and risk management processes and related controls... .... GAAS, and PCAOB standards Utilize digitization and automation for... ...range of benefits, including medical, dental, vision, 401k, holiday...MedicalFull timeWork at office$96k - $141k
Internal Audit-New York- Associate, Business Audit - 9234965 location... ...control structure, including management and performance of the audit... ...to the control environment, utilizing Significant and Complex... ...location. These generally include medical, dental, short‑term...MedicalFull timeTemporary workWork experience placementWork at officeLocal area$72k - $184.44k
...to 40% At PwC, our people in audit and assurance focus on... ...assessing governance and risk management processes and related controls... ...tailored to private companies Utilizing exceptional technical knowledge... ...range of benefits, including medical, dental, vision, 401k, holiday...MedicalFull timeH1b- ...We’re seeking a dedicated and detail-oriented Utilization Management Registered Nurse (UM RN) to join our growing healthcare team. In this... ...of inpatient, outpatient, and SNF services to assess medical necessity, appropriateness, and efficiency using evidence-based criteria...MedicalRemote work
- Audit Manager (2600028T) Organization Auditor of State Agency Contact Name and Information... ...ensure that taxpayer dollars are being utilized by public entities according to the letter... ...Certification Reimbursement Program Medical Benefits (Dental and Vision)...MedicalFull timePart timeWork at officeImmediate startFlexible hours
- ...healthcare staffing agency in New York is seeking a Clinical Utilization Specialist to oversee the authorization of services for geriatric... .... Responsibilities include reviewing health services for medical necessity and collaborating with care teams to ensure quality care...Medical
$70k - $90k
...This role, at the Associate or Senior Associate level, involves auditing healthcare provider claims and documentation. Candidates should... ...interest in healthcare compliance, and prefer experience in medical auditing. Salary for Associates ranges from $70,000 - $90,000 and...Medical- ...organization in New York, NY is seeking a Clinical Care Manager responsible for coordinating and managing... ...are essential, alongside proficiency in Utilization Management criteria. This role includes conducting medical necessity reviews and maintaining compliance with state...Medical
$241k - $290.06k
...provider in New York seeks a Physician Advisor to join their Utilization Management team. This role involves optimizing care levels,... ...compliance, and serving as a liaison for practice patterns and medical necessity issues. Candidates should have Board Certification in...Medical$150k
...standards (e.g. refer to specific PwC tax and audit guidance) the Firm's code of conduct, and... ...a vision and establish direction- Utilizing automation and digitization in professional... ...offers a wide range of benefits, including medical, dental, vision, 401k, holiday pay,...MedicalTemporary work- ...Currently seeking a Utilization Management RN . Please see details and qualifications below: Position... ...PA. ** Minimum of three (3) years of Medical/Surgical experience. ** Previous Acute... ...record review to determine medical necessity for services. Using advanced clinical...MedicalImmediate startRemote workDay shift
$71.1k - $97.8k
...leading health organization is seeking a Utilization Management Registered Nurse to support coordination and documentation of medical services. The ideal candidate holds a Compact... ...include interpreting medical necessity criteria and facilitating member care. The...MedicalRemote job- ...About The Role BHPS provides Utilization Management services to its clients. The Utilization Management Nurse performs medical necessity and benefit review requests in accordance with national standards, contractual requirements, and a member’s benefit coverage while working...MedicalContract workWork at officeRemote work
- ...and provide, ongoing coordination and management of service delivery through an integrated... ...case management approach. Performs medical necessity review that includes concurrent, prospective... ...and quality standards related to Utilization Management. Maintain and submit...MedicalWork at office
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