authorization or concurrent review within an insurance company and/or managed care organization. Experience leading a remote team... organization and monitoring of all medical services. Responsible for direct supervisory oversight of professional and front line...
review experience at a Managed Care Organization or Health Plan required. Working knowledge of Medicaid and/or Medicare...RN- Utilization Review Nurse Inpatient *Full Time - 100% Remote Opportunity* Must reside within the New York Tri...
. Provides first level RN review for all outpatient and ancillary prior authorization requests for medical appropriateness... and medical necessity using appropriate criteria, referring those requests that fail review to the medical director for second...
in a managed care setting including utilization review RN experience in a clinical setting required Leadership and/or management...Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage...
of illness, and/or highly complex medical/behavioral and social conditions. The goal is to improve members' quality of life... is responsible for evaluating members’ medical and behavioral health histories to determine eligibility for enrollment in the PRC...
Utilization Management staff. Oversee staff performance with regard to medical necessity determinations, concurrent review...-driven organization with more than 30 years of experience. We deliver comprehensive, outcomes-driven care to those who need...
information, medical necessity standards, and/or and InterQual guidelines. The Utilization Review Nurse utilizes clinical... knowledge to support the coordination and documentation and communication of medical services and/or benefits. The Utilization...
Support Staff Quality Review Specialist (QRS) is responsible to complete ongoing audits of Support Staff, analyze... with Coordinated Care management. Support Staff Quality Review Specialist (QRS) is responsible for quality assurance, accuracy...
Management (ERM) Financial Risk Department, is looking for a Head of Capital Basel Policy Review to join its Capital Risk..., and prudently managed in support of our business strategy. As such, ERM provides risk oversight, support, and coordination to ensure...
Experience working with Commercial, Medicare, and Medicaid plans Utilization Review background in managed care Pay is based...Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives...
Experience working with Commercial, Medicare, and Medicaid plans Utilization Review background in managed care Pay is based...Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives...
in case management and/or utilization review preferred. OUR BENEFITS: Medical, Dental, Vison insurance. Acadia...Description : Burkwood Treatment Center is seeking a Utilization Review Specialist who is responsible for monitoring...
Utilization Review Physician Advisor (Advisor) position conducts timely and compliant medical necessity reviews and assists...Job Category: Physicians and APPs Degree Level: Doctorate Degree Job Description: Inova Fairfax Medical Campus...
of utilization review or case management experience in a managed care organization or commercial insurance. Oregon residency...Job Description JOB TITLE Utilization Review Nurse REPORTS TO Utilization Review, Manager STATUS FT, Exempt WAGE RANGE...
in utilization chart review and discharge planning. Managed care experience preferred. Knowledge of InterQual Criteria... Regional Medical Center is located in Wellington, Florida. It is a 235-bed, acute care hospital, owned by a subsidiary...
in utilization chart review and discharge planning. Managed care experience preferred. Knowledge of InterQual Criteria... Regional Medical Center is located in Wellington, Florida. It is a 235-bed, acute care hospital, owned by a subsidiary...
Reports to the Director, Managed Care and Medical Director of Community Health Alliance (CHA). Conducts effective..., medical terminology and record systems and a strong understanding of managed care. Demonstrates the analytical skills...
assessment, family motivation, treatment planning and communication with external review organization or comparable entities... you regain control of your life. Website: We are looking for a Utilization Review Clinician to join our team! In this role...
assessment, family motivation, treatment planning and communication with external review organization or comparable entities... you regain control of your life. Website: We are looking for a Utilization Review Clinician to join our team! In this role...
management in a Managed Care Organization required. Certified in Utilization Review or Case Management preferred... in a Managed Care Organization required. Certified in Utilization Review or Case Management preferred. Required less than 1 year...