Post Service Clinical Review nurse will report to the manager of FEP Post Services. In this role you will be reviewing... claims and medical records review of services rendered to FEP members. Post-Service Clinical Nurse reviews for medical...
balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct... clinical information, apply guidelines, and make determinations. Document findings and rationale in medical management systems...
balance, continuous learning, and career development. Summary We are seeking a skilled Utilization Review Nurse to conduct... clinical information, apply guidelines, and make determinations. Document findings and rationale in medical management systems...
more at: Job Summary: The Utilization Review (UR) Nurse (initial clinical reviewer) is a registered nurse (RN) or who possesses an active... (U.S.) that the organization provides utilization management (UM) services, if the UR RN is reviewing clinical cases in that state...
more at: Job Summary: The Utilization Review (UR) Nurse (initial clinical reviewer) is a registered nurse (RN) or who possesses an active... (U.S.) that the organization provides utilization management (UM) services, if the UR RN is reviewing clinical cases in that state...
Role Overview Under the supervision of the Manager for Utilization Management, this position is responsible... for providing daily oversight of Utilization Management Reviewers, Utilization Management Review Technicians and staff members...
Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management... Collaborates with utilization management team to resolve complex care member issues Maintains knowledge of regulations...
in behavioral health and/or substance use disorder. Managed care and utilization management experience required. Licensure: RN...Role Overview: The After Hours Behavioral Health (BH) Utilization Management (UM) Reviewer is scheduled to work non...
Utilization Management required 3 years previous leadership experience required Licenses and Certifications RN - Registered...Director Utilization Management-Clinical Review Are you looking for a rewarding career with family-friendly hours...
Role Overview: Under the direction of a supervisor, the Utilization Management Reviewer evaluates medical necessity... based on clinical criteria. Using professional judgment, the Utilization Management Reviewer assesses the appropriateness...
. And we do it all with heart, each and every day. Position Summary This is a fully remote Utilization Review Clinical Consultant... and external constituents in the coordination and administration of the utilization/benefit management function. Utilizes clinical...
. Knowledge of utilization management principles preferred. Must have a CA RN License License/Certification: RN - Registered... Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management...
This is a remote position open to candidates nationwide. Candidates must have a Registered Nurse (RN) license for California... Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management...
utilization management position that has core responsibilities in the areas of inpatient concurrent review, pre and post service... utilization review, and collaboration with RN Case and disease managers. This director position will report to the Sr. Medical...
care to members. Oversees and works with senior leadership on utilization management issues related to member care..., provider interactions, and facilitates operations within utilization management. Oversees the behavioral health (BH...
Healthcare Magazine named us in its “Top 100 Places to Work.” Overview: The Utilization Management Case Manager works as part... needed. Utilization Management: When assigned UM tasks, the UM/CM must: Perform pre-authorization, concurrent, and discharge review...
such as Certified Case Manager (CCM), Accredited Case Manager (ACM), Certified Managed Care Nurse (CMCN), Case Management, Board...Responsible for utilization review work for behavioral health admissions and continued stay reviews. Responsibilities...
of Washington (WA) to be considered Care Manager RN Per diem / On call Day shift The Utilization Review (UR) Nurse...Job Category: Health Information Management Job Description: This is a remote role. You MUST live in the state...
in emergency room, critical care and/or medical/surgical nursing At least 2 years utilization management experience in acute... setting in emergency room, critical care and/or medical/surgical nursing At least 3 years utilization management experience...
. At least (3) three years of professional experience is required. You must hold a valid Registered Nurse License (RN)..... Schedule You will work primarily remote. Will be required to work onsite at a BSW facility for quarterly meetings...