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$52.26 - $81.13 per hour
...Description The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports the UM program by developing...SuggestedMinimum wageFull timeLocal areaShift work- Overview Primary purpose: To assign utilization review requests; to verify and enter data in appropriate system(s); and to provide general support to clinical staff in a team environment. Responsibilities Accesses, triages and assigns cases for utilization review (UR)....SuggestedWork at officeLocal area
- ...plan of care for members based on authorization and concurrent review. Provides monthly telephonic outreach to ensure members needs are... ...network services, and appropriateness of treatment setting by utilizing the applicable medical policy and industry standards,...SuggestedContract workRemote workMonday to FridayFlexible hours
- ...appropriateness of the treatment plan in the context of insurance or managed care. Qualifications Required: RN with IL Active License, with Utilization experience; familiar with MCG and ASAM criteria. Preferred: Inpatient hospital experience or ER background. Seniority level Mid-...SuggestedContract work
- Description Job Summary The UR Coordinator’s primary responsibility is managing, reviewing, and monitoring utilization of patient resources and obtaining payor authorization as required for all provided services. The UR Coordinator will function as liaison between payor...SuggestedTemporary workWork at officeLocal area
- ...medical necessity and appropriateness of the treatment plan . This position is responsible for performing accurate and timely medical review of claims suspended for medical necessity, contract interpretation, pricing; and to initiate and/or respond to correspondence from...SuggestedFull timeContract workRemote work
$4,801.16 - $7,761.5 per month
...advancement, and more. Benefits of Working at HHS webpage contains additional details. Position Details Functional Title: Utilization Review Nurse Job Title: Nurse II Agency: Health & Human Services Comm Department: UR Wav & Comm Srvs Ran Mmt St Posting Number:...SuggestedFull timeTemporary workPart timeWork at officeRemote workShift work- ...knowledge of local and national coverage determinations Recent work experience in a hospital or insurance company providing utilization review services Knowledge of Medicare, Medicaid, and Managed Care requirements Progressive knowledge of community resources, health...SuggestedPermanent employmentWork experience placementLocal area
- ...want to impact others in a meaningful way, we warmly invite you to join our growing family! We are currently seeking to hire Utilization Review Specialists to join our corporate NJ Team! The Utilization Review Specialist collaborates with Avenues Recovery facilities...SuggestedTemporary workCurrently hiringFlexible hours
$35 - $40 per hour
Base Pay Range $35.00/hr - $40.00/hr Location Fully Remote Position Summary The Utilization Review Nurse serves as a key liaison in coordinating resources and services to meet patients’ needs, ensuring efficient, cost-effective, and compliant delivery of home health...SuggestedContract workRemote workFlexible hoursWeekend work- ...and healing environment that improves patient outcomes and empowers patients toward long-term recovery. Position Summary The Utilization Review Specialist is responsible for managing all aspects of insurance authorization and concurrent review for assigned patients....Suggested
- ...Utilization Review Manager We are currently seeking a Utilization Review Manager to join our Transitional Care Team. This is a full-time management role and will be required to work onsite. The purpose of this position is to manage the design, development, implementation...SuggestedFull timeWork at office
- ...coast. We are driven by a profound commitment to prioritize your well-being so you can provide exceptional care to others. As a Utilization Review Director joining our team, you're embracing a vital mission dedicated to making communities healthier. Join us on this...SuggestedFull timeTemporary workPart timeWork at office
$45.9 - $71.4 per hour
Utilization Review RN - Remote The RN Care Coord-Qual Med Mgmt will provide administration of medical management programs for prior authorization. These programs are developed to manage medical expense, determine medically appropriate services and define clinical criteria...SuggestedRemote jobLocal area- Via Linda Behavioral Hospital in Scottsdale is seeking a Utilization Review Coordinator to manage the assessment and efficiency of services. This role involves interfacing with external payors and promoting high-quality patient care through clinical evaluations. Candidates...SuggestedWork at officeWeekend work
- A leading pharmacy benefit manager is seeking an Initial Review Pharmacy Technician in Des Moines, Iowa. The role involves critical tasks in medical and pharmacy management, such as reviewing requests for medication appropriateness and providing clinical consultation to...
- ...Monday - Friday from 8am-4:30pm. Requirements 2 years of RN experience performing care for hospitalized patients 2 years of Utilization Review (UR) experience reviewing hospital admissions for medical necessity Must live within one hour of the BJC Commons (4249 Clayton...Full timeReliefLocal areaRemote workWork from homeMonday to FridayFlexible hoursShift work
- ...organization in New York, NY is seeking a Durable Medical Equipment Review Coordinator to ensure high quality, cost-effective services... ...least two years of managed care experience. Familiarity with utilization management and case management is strongly preferred. This...
- Responsibilities We are pleased to announce the following available position: FT Utilization Review Coordinator, including weekends. This position is responsible for monitoring the treatment activities offered to the patient, interfacing with the treatment team/managed...Local area
- A leading behavioral health facility in Georgia is seeking a Utilization Review Coordinator to join their Case Management team. This role requires a Master's level education in social science and must also be licensed or license-eligible in Georgia. The ideal candidate...
$17.44 per hour
A state agency in Tulsa is seeking a Utilization Review Specialist I responsible for reviewing clinical documentation to ensure the appropriateness of admissions and ongoing care. The position requires a bachelor's degree or equivalent experience in social work or psychology...Hourly payFull time- A leading healthcare provider in Jacksonville is seeking a TEMP FT Utilization Review Coordinator to monitor treatment activities and ensure quality patient care. The ideal candidate will have a nursing or social work background with experience in Utilization Management...Temporary workWeekend work
$72.23 - $99.98 per hour
...RN Case Manager assists patients in the utilization of appropriate health care services.... ...required to know and understand will be reviewed and evaluated during job specific/department... ...s services, emergency and trauma care, pediatrics and neonatal intensive care. Our not-...Daily paidMinimum wageLocal areaShift work- ...Director Of Utilization Management $10,000 Sign On Bonus Riveredge Hospital is seeking a talented and dynamic Director of Utilization... ...services and interfaces with managed care organizations, external reviewers and other payers. Duties include, but are not limited to:...Work at officeLocal areaRelocation package
- ...Manager Centralized Utilization Review At Houston Methodist, the Manager Centralized Utilization Review (UR) position is responsible for leading the daily operations of the Utilization Review department to ensure efficient, high-quality, and compliant utilization management...Permanent employment
$27.02 - $48.55 per hour
...psychiatric experience. Position Purpose Performs a clinical review and assesses care related to mental health and substance abuse... .... Analyzes BH member data to improve quality and appropriate utilization of services. Provides education to providers, members and their...Hourly payFull timePart timeWork at officeRemote workMonday to FridayFlexible hoursWeekend work- Sedgwick is seeking an Administrative Support Specialist in Town of Florida, New York. The role involves managing utilization review requests, verifying data, and providing general support to clinical staff. Candidates should have a High School diploma or GED and two years...Work at office
- A leading healthcare staffing firm is seeking a Registered Nurse for Concurrent Review in Florida. The role involves telephonic review of inpatient admissions to ensure appropriate medical necessity and care levels. Candidates must have an active RN license in Florida...Full timeWork at officeMonday to Friday
$30.37 - $59.21 per hour
...DESCRIPTION This role provides support for clinical member services review assessment processes. Responsible for verifying that services... ...teams to promote the Molina care model. Adheres to utilization management (UM) policies and procedures. Required Qualifications...Hourly payWork experience placementWork at officeRemote workShift workWeekend work- A leading healthcare company is looking for a Physician Clinical Reviewer - Dermatology for a remote position. The successful candidate will review medical cases, interact with physicians, and ensure compliance with clinical guidelines. An MD/DO/MBBS degree is required...Remote jobWork from home