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...

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 The RN Case Manager is responsible for carrying out effective case management functions for identified patients by planning, coordinating, negotiating, procuring and managing the care and needs of complex patients and their fa...

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...

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...

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on ...

Review Specialist reviews and processes Senior Care Options (SCO) and One Care medical claims requiring manual intervention...

The Utilization Review Coordinator 2 reviews medical records of clients who are receiving treatment for mental illness... to ensure proper utilization of treatment resources. The position reviews client records for proper case documentation...

, Life Science, Research Grants, Scientific Reviews, Waterfall Model Certifications: None Experience: 5 + years...

quality and cost effective health care services. Some of your daily activities will include: Reviews planned, in process... and Performance Improvement Initiatives. Timely follow-up on results of denial and internal appeal reviews. We would like to speak...

reviews as requested; and with scheduling meetings, maintaining policies, and supporting departmental projects. Work...

team and performance of reviews, with external review organizations/managed care companies. Discuss with patient various...

and state criminal and civil codes; employment law; insurance; FINRA and CIRO regulations related to background reviews..., ongoing and post disclosure background reviews are completed within department policies and processes. Responsible...

and process improvements Support Integrated Product Teams (IPTs) and actively participate in design reviews Represent...

reviews for mental health services. Clinicians who reside in Arkansas or have knowledge of Arkansas specific resources... level of care and services are medically appropriate Performs prior authorization reviews related to mental health...

regarding the interpretation of compliance methods when preparing for regulatory reviews, the interpretation of regulatory... review efforts by: conducting utilization and performance reviews utilizing multidisciplinary criteria and guidelines...

summary report reviews Reviewing state and federal compliance Handling inbound and outbound calls WHAT WE NEED...