clinical reviews and denial appeals where appropriate either during admission or post discharge. Providence caregivers...

Description The Utilization Review (UR) Nurse has a strong clinical background blended with a well-developed knowledge and skills in Utilization Management (UM), medical necessity and patient status determination. This individual supports...

Description Responsible for providing utilization review and coordination of care throughout the healthcare continuum to promote quality and cost effective care to the members. Providence caregivers are not simply valued – they’re inval...

Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encoura...

Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encoura...

Hospitals on Incredible Health are actively hiring and accepting applications in the Macon, GA area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encoura...

Hospitals on Incredible Health are actively hiring and accepting applications in the Jackson, MI area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encou...

Hospitals on Incredible Health are actively hiring and accepting applications in the Jackson, MI area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encou...

Hospitals on Incredible Health are actively hiring and accepting applications in the Jackson, MI area for the following position: Registered Nurse - Utilization Review. Nurses with experience in any of the following areas are strongly encou...

managing all aspects of credit risk reviews. The position requires a self-driven, problem solving individual... that has a strong credit review background. Responsibilities Lead target reviews, continuous monitoring reviews and risk assessments...

Summary of Position Perform clinical reviews within the Medical Management Operations Concurrent Review utilization... appropriate clinical reviews and patient care. Enter and maintain documentation in the TPH platform meeting defined timeframes...

. This is a position in the Land Use Review division, which reviews and provides case management services for and from initial submission...

each stage and PMRC approval process. Reviews final production proofs provided by Commercial, conducts some functional reviews...

and medical necessity reviews of prior authorization requests in accordance with established guidelines and criteria Evaluate... in Prior Authorization (PA) or Inpatient (IP) reviews within an insurance/health plan environment Active LPN license...

clinicians to support Applied Behavior Analysis (ABA) clinical reviews and authorization assessments. Resources... reauthorizations, clinical reviews, and appeals as applicable Ensure documentation is complete, compliant, and audit ready...

clinicians to support Applied Behavior Analysis (ABA) clinical reviews and authorization assessments. Resources... reauthorizations, clinical reviews, and appeals as applicable Ensure documentation is complete, compliant, and audit ready...

-in-Charge, executing transaction reviews, secondary reviews of transactional testing completed by others, and issues management... process execution for new and existing clients, providing direct and timely feedback on transactional reviews Provides...

, executes audit procedures, supervises and reviews the work of others, analyzes and synthesizes results of testing performed...

reviews to address complex management and systemic problems and formulate recommendations for the effective solution of these... reviews to determine compliance with laws, rules, policies and procedures and to assess the quality of services provided...

. This position reviews both capital and private development projects for conformance with adopted codes and statutes. Essential... Duties: Reviews, processes, and approves private development engineering plans, reports, model outputs...