Role Overview As a Generalist, you will leverage your diverse background to review, assess, and provide structured feedback on domain-specific documents. This role is ideal for professionals with strong analytical skills and expertise in co...

Role Overview As a Generalist, you will leverage your diverse background to review, assess, and provide structured feedback on domain-specific documents. This role is ideal for professionals with strong analytical skills and expertise in co...

Role Overview As a Generalist, you will leverage your diverse background to review, assess, and provide structured feedback on domain-specific documents. This role is ideal for professionals with strong analytical skills and expertise in co...

Description We are hiring for Care Manager RN positions at Providence Alaska Medical Center in Anchorage, AK! Join us as a Care Manager to play a vital, hands‑on role during a transformational time in our department. Work at the top of ...

Description We are hiring for Care Manager RN positions at Providence Alaska Medical Center in Anchorage, AK! Join us as a Care Manager to play a vital, hands‑on role during a transformational time in our department. Work at the top of ...

Description We are hiring for Care Manager RN positions at Providence Alaska Medical Center in Anchorage, AK! Join us as a Care Manager to play a vital, hands‑on role during a transformational time in our department. Work at the top of ...

Build your Career with an Industry Leader As the global leader of premium labels, MCC helps brands stand out in competitive markets and inspire positive consumer experiences. Backed by over a century of printing experience, MCC is focused...

SSM Health is an Equal Opportunity Employer:Community Description:About SSM Health St. Mary's Hospital - Madison: SSM Health-Dean Medical Group, a 500-physician multi-specialty group, is actively recruiting a Cardiothoracic Surgery Physic...

Multi-Specialty Peer Review Committee Coordinator in San Francisco/Bay Area contract Opportunity! This Jobot Consulting Job is hosted by: Robert Reyes Are you a fit? Easy Apply now by clicking the "Apply" button and sending us your resu...

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

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

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

Neuropsychiatric Hospital, supporting inpatient, partial hospital, and intensive outpatient programs. Performs clinical reviews...

authorizations. This position receives and reviews prior authorization requests for specific inpatient and outpatient medical... necessity reviews for retrospective authorization requests as well as claims disputes. The Utilization Review Nurse will use...

Job Summary: Responsible for carrying out medical necessity reviews on all designated referrals for Home Care, DME... established criteria and guidelines for coordination of services. Eligibility and benefit reviews will be performed as necessary...

as well Responsibilities: Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical...

services. Through regular utilization reviews and audits, the UR nurse ensures that patients receive the care they need without... Management (UM) reviews of various types, enter notes, locate insurance information, provide clinical updates to 3rd Party payors...

prompting and follows up to ensure completion, including peer-to-peer reviews, securing admission orders, and reporting quality... issues. Reviews concurrently all inpatients, including critical care, every three days or sooner if payor requests...

Reviewing necessary medical record reviews and making a determination on hospital appeals. Supervising and training RNs... clinical Program Integrity efforts with ODM contractors and managed care plans Presenting findings from clinical reviews...

requirements. The Opportunity As part of the Risk & Independence team you will lead Partner-level reviews that shape PwC...