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Clinical Document Integrity (CDI) Lead
AMN Healthcare
Case management, utilization review and/or direct provider interaction experience
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Clinical Document Integrity (CDI) Lead
AMN Healthcare
Case management, utilization review and/or direct provider interaction experience
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Utilization Management Clinical Consultant - OhioRISE - must reside in Ohio
CVS Health
1+ years of Utilization Review/Utilization Management experience required.
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Manager, Advisory Services
Premier Healthcare Solutions, Inc.
Maintain utilization targets for client billable projects
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RN Senior Review Coordinator PT - Saturday's and Sunday's
Telligen
As a Senior Review Coordinator RN, you will be responsible for conducting utilization review/medical management for all services, including training/mentoring other team members, and…
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Quality Improvement Coordinator II
Centene Management Company LLC
Conduct review of delegated entities for compliance with quality, service performance and utilization, credentialing reviews and medical record audits. Perform community activities related…
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Utilization Management Nurse Consultant (Work From Home)
CVS Health
Utilization Management Nurse Consultant Clinical Precertification RN (Medicare Home Care)
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Utilization Management Clinician Behavioral Health Night Shift - 4 Days
Aetna Resources, LLC
Behavioral Health Utilization Management Clinician
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Utilization Management Nurse Consultant
Aetna Resources, LLC
Are you an experienced RN looking to leverage your clinical expertise in a non-bedside role? Join our Utilization Management team and help ensure members receive the right care at the right…
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Group Health Oncology Utilization Review Nurse - Clinical Review Preparation
Dane Street, LLC
The QA Specialist plays an integral role in the review process as they are responsible for communicating with the customer, reviewer, and management to ensure a completed report is…
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RN Care Management Supervisor (Maternity/NICU Focus)
BlueCross and BlueShield of South Carolina
…maintenance of the daily functions of the following areas: Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals,…
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Utilization Management Behavioral Health Professional
Humana Insurance Company
Humana Healthy Horizons in Kentucky is seeking a Utilization Management Behavioral Health Professional 2 who utilizes behavioral health knowledge and skills to support the coordination,…
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APP I, Behavioral
KDMC Ashland Hospital Corporation
Adherence to department-specific clinical guidelines, schedules, volume expectations, and equipment utilization as directed by clinical leadership and departmental policy.
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Utilization Management Nurse Consultant
Aetna Resources, LLC
Utilization Management Nurse Consultant - Clinical Precertification RN (Medicare)
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Utilization Management Clinical Consultant - OhioRISE - must reside in Ohio
Aetna Medicaid Administrators
1+ years of Utilization Review/Utilization Management experience required.
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Utilization Review WEO RN
CoxHealth
The Utilization Review Nurse RN collaborates with the physician and members of the multidisciplinary team to facilitate progression-of-care; monitors the patient's progress, intervening…
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Registered Nurse Clinical Information Specialist
Banner Health Corporate
Join Banner Health's Utilization Review Department (BHURD) as a fully remote RN, where your acute bedside expertise will directly impact patient care across our entire health system. With a…
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Clinician, Clinical Response
About Us
Utilizes clinical expertise in behavioral health, including assessment, crisis intervention, motivational interviewing, utilization review, and care recommendations to support members…
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Case Manager - Utilization Management
Lehigh Valley Hospital
2 years of previous utilization review experience. and
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Behavioral Health Service Mgr
Centene Management Company LLC
Master's degree in Behavioral Health. 3+ years of case and/or utilization management experience. Experience in psychiatric health care settings, child behavioral health conditions and…
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Market Physician Executive - Pennsylvania
Monogram Health
…of the advanced practice providers, the MPE is expected to review and approve care plans and direct the treatment plans for our patients. The MPE will collaborate with community physicians,…
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Register Nurse Utilization Review
Ascension
Champion regulatory and compliance standards across utilization management practices to safeguard quality care delivery and uphold federal and third-party payer guidelines.
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Clinical Care Reviewer II - Behavioral Health
CareSource Management Services LLC
Utilization Management/Utilization Review experience preferred
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RN Quality Care Coordinator
Network Health
Evaluate utilization patterns, medical records and other metrics to monitor quality and efficiency results
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Analyst, Appeals
Palmetto GBA
Required Work Experience: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience or a combination of experience in clinical,…