Description Utilization Review RN at Providence Health Plaza. Utilization Management covers 7 days/week, including holidays. This posting is not for a specific job vacancy. It serves to establish a place for current or future interested...

of MCG and Utilization Review requirements for concurrent and initial reviews Utilization review, Case management... equipment for chart reviews Performs inpatient and observation utilization reviews Reviews medical necessity using clinical...

case reviews, check medical records, speak with patients and care providers regarding treatment, and respond to the plan...

TravSource is seeking a travel nurse RN Case Manager, Utilization Review for a travel nursing job in Tuba City, Arizona. Job Description & Requirements Specialty: Utilization Review Discipline: RN Start Date: 09/07/2026 Duration: 13 ...

. Documentation and Reporting: Document findings from utilization reviews in the appropriate systems and ensure accurate record...

Responsibilities The Valley Health System has expanded into an integrated health network that serves more than two million people in Southern Nevada. Starting with in 1979, the Valley Health System has grown to include , , Benefit Highl...

We’re seeking a future team member for the role of Director, Credit Risk Review to join our Model Risk team. This role is located in New York City, New York. In this role, you’ll make an impact in the following ways: Lead the development...

Oversees service delivery authorizations and provides quality assurances of service delivery records Reviews all service...

and their families. What You'll Do Conduct independent, remote case reviews evaluating medical necessity, appropriateness, or quality... report. Most cases take 1-3 hours to complete; shorter reviews may take less than 1 hour Strong written communication...

. Candidates must have a NJ license. JOB SUMMARY: Relying on clinical background, reviews health claims providing medical.... Responsibilities: MAJOR DUTIES AND RESPONSIBILITIES: Reviews medical files and provides recommendations for utilization review, chart...

Responsibilities Coordinates and completes the clinical reviews for all patient medical records while working closely...

. How you'll contribute A Utilization Review Specialist who excels in this role: Facilitates clinical reviews for all patient... reviewers, and other payers. Communicates with physicians to schedule peer-to-peer reviews. Accurately reports denials...

established guidelines, this role reviews and processes requests from physicians, medical groups, pharmacies, and members... appeal reviews. Handle inbound calls from provider offices and members who return calls or seek updates on their appeals...

of and keeping of records of reviews; keeps records of and provides billings of fees; and ensures proper filing and logging of plans.... Reviews development applications and supporting documents to ensure that all required documents are included in the submittals...

of veterans represented $350M+ in lifetime benefits secured for the people who served 4.9-star client rating across 634 reviews...

established guidelines, this role reviews and processes requests from physicians, medical groups, pharmacies, and members... appeal reviews. Handle inbound calls from provider offices and members who return calls or seek updates on their appeals...

and continued stay reviews, possibly from an offsite location Provides inpatient and observation (if indicated) clinical reviews... and communication related to the FCC, payor, physician, physician advisor and in-house care management Second-level physician reviews...

Required Qualifications Series 7 and 24 are required Must have performed redline day to day regulatory reviews of marketing content...

for services denied. How you will make an impact: Conducts pre-certification and appropriateness of treatment setting reviews...

Completes due diligence reviews, targeted portfolio assessments, and other ad hoc assignments as needed Follow all established...