denial of the request. The Nurse Reviewer must follow each line of business' requirements and each accrediting body's (CMS.... Settings include inpatient, outpatient, in-state, out-of state and out-of country. Document clinical case summary and review...
needs to obtain their own laptop SOAZ – Posting ID # 5297 - Medical Review Nurse (Local Only/Mostly Remote/Onsite... program Good written and communication skills Computer skills Utilization Review skills Medical Claims Review...
, utilization review, managed care organization quality review, and quality assurance for programs serving individuals.... Best People, Best Solutions, Best Results Job Summary: Performs medical record and claims review for Medicare, Medicaid...
is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services..., medical necessity) CPS_Review Existing Clinical Documentation Review/interpret clinical/medical records submitted...
experience Case Management experience Skilled Nursing or Rehab experience Background that involves utilization review... an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review...
experience Case Management experience Skilled Nursing or Rehab experience Background that involves utilization review... an opportunity to deliver the next generation clinical model, integrating services from precertification, inpatient concurrent review...
in utilization review, case management, or clinical quality improvement, preferred Proficient technical skills in Microsoft Office... utilization and care management. We have gained this position by actively working to change out-of-date practices...
in utilization review Disqualifiers: not independently licensed in AZ, not living in AZ Additional qualities to look... for: expertise reviewing BH medical charts, treatment plans, any experience in BH utilization review. Candidate Requirements...
now, the team is working to complete review Should have a 10 -12 caseload per day, the team right now is handling a caseload... as needed to discuss member care being delivered Collects, documents, and maintains concurrent review findings, discharge plans...
: 6 months, contract to hire. Job Purpose: Right now, the team is working to complete review Should have a 10 -12..., documents, and maintains concurrent review findings, discharge plans, and actions taken on member medical records in health...
Review Clinician works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization... review and prior authorizations (as needed) according to Molina policy for Molina members as part of the Utilization...
utilization and quality review through the monitoring of care provided during hospitalization and certain out-patient procedures... according to utilization management guidelines for workers compensation and group accounts. Review includes pre-certification...
communities and residents and to support the safety net required to achieve that purpose. Job Summary The Utilization...) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests...
. Refers cases requiring clinical review to a nurse reviewer; and handles referrals for specialty care. Processes incoming...Anticipated End Date: 2025-11-03 Position Title: Utilization Management Representative II (Virtual in Ohio...
Review Clinical Review team to ensure appropriate care to members. Supervises day-to-day activities of utilization management... between utilization management team, members, and providers Monitors prior authorization, concurrent review, and/or retrospective...
Organ Utilization Coordinator DonorConnect is looking for a full-time Organ Utilization Coordinator to support... for life-saving transplants. Our employees help save and heal lives! The Organ Utilization Coordinator (OUC) is primarily...
Utilization Management is responsible for leading and optimizing the hospital's utilization review processes to ensure appropriate... oversees a team of utilization review nurses and analysts, collaborates with interdisciplinary teams, and drives initiatives...
utilization management activities, which may include telephonic or onsite clinical review; case or disease management, care...Remote Utilization Management RN Leading healthcare facility that aims to improve the health and wellness...
clinical review to a Nurse reviewer. Responsible for the identification and data entry of referral requests into the...Anticipated End Date: 2025-10-10 Position Title: Utilization Management Representative I (Miami, FL...
clinical review to a Nurse reviewer. Responsible for the identification and data entry of referral requests into the...Anticipated End Date: 2025-10-10 Position Title: Utilization Management Representative I (Florida...