Overview: Medicare Medical Review RN (Medical Reviewer III) - REMOTE The Medicare Medical Review RN (Medical... of medical terminology and experience in the analysis and processing of Medicare claims, utilization review/ quality assurance...
role The Pre-Certification Review Nurse - Pharmacy is responsible for reviewing and processing coverage determinations... and utilization management reviews for specialty medications, to include site of care assessments, for enrollees of Quantum Health...
Medical Review RN / Nurse Specialist II Work from Home within the Continental United States @Orchard LLC..., utilization review, managed care organization quality review, and quality assurance for programs serving individuals...
Medical Review RN / Nurse Specialist II Work from Home within the Continental United States @Orchard LLC..., utilization review, managed care organization quality review, and quality assurance for programs serving individuals...
’ experience Utilization Review experience 1+ years’ experience Managed Care Strong telephonic communication skills 1+ years... & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation...
’ experience Utilization Review experience 1+ years’ experience Managed Care Strong telephonic communication skills 1+ years... & Responsibilities Drives effective utilization management practices by ensuring appropriate and cost-effective allocation...
’ experience Utilization Review experience 1+ years’ experience Managed Care Strong telephonic communication skills 1+ years... to simplify health care one person, one family and one community at a time. Position Summary This Utilization Management...
. Key Responsibilities Create, review, and audit medical determination letters including approvals, extensions... attention to detail and process consistency Required Qualifications Registered Nurse (RN) with an active, unrestricted...
, including occasional rotating weekend and holiday schedules. Preferred Qualifications: Managed care/utilization review... schedule based on business needs LCSW, LCPC, RN with experience in psychiatric setting required. Utilizes clinical skills...
in Louisiana Managed care/utilization review experience preferred Experience in a behavioral health inpatient setting Ability... schedule based on business needs LCSW, LCPC, RN with experience in psychiatric setting required. Utilizes clinical skills...
in Louisiana Managed care/utilization review experience preferred Experience in a behavioral health inpatient setting Ability... schedule based on business needs LCSW, LCPC, RN with experience in psychiatric setting required. Utilizes clinical skills...
perspective on workplace flexibility. Position Purpose: Supervises the behavioral health (BH) utilization review clinicians... behavioral health (BH) utilization review clinicians and ensures compliance with applicable guidelines Monitors and tracks UM BH...
Purpose: The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the utilization review... and support team (RN, Physician/Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to progress each patient's care...
Purpose: The Registered Nurse Utilization Review (UR), Clinical Care Manger (CCM) actively manages the utilization review... and support team (RN, Physician/Clinical Affiliate, DPA, MSW, CDI, Rehab Services, etc.) to progress each patient's care...
is designed to address the growing need for high-quality behavioral health services in the region. The Utilization Specialist... proactively monitors utilization of services for patients to optimize reimbursement for the facility. Responsibilities...
coordination. Oversee the utilization review process, ensuring appropriate utilization of services and adherence to best practices... to utilization management and patient care quality. Qualifications: Education: RN BSN, with a valid multistate license. Master...
of Science degree in Nursing. Experience/Skills: Required: 1. Two year’s experience in utilization review, case management..., or relevant clinical experience. 2. Knowledge of utilization review practices and principles. 3. Ability to form positive...
Overview: Mirror Lake is hiring for a Utilization Specialist! Proactively monitor utilization of services... statistical and narrative information to report on utilization, non-certified days (including identified causes and appeal...
and operational leadership to the day to day function of the Utilization Management Team. The UM Nurse Manager will ensure that the... team complies with timeliness, documentation, notification and review quality standards based on the Federal, State, Health...
RN license in AL A minimum of 3 years’ experience in an acute care setting and 2 years’ experience in utilization review... for Utilization Management Registered Nurse: Develop, implement, and administer the quality assurance and utilization review...