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 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 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...

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...

About Us: 4LEAF, Inc. (4LEAF) is a multi-discipline Firm providing services throughout the United States. For over 20 years, 4LEAF has assisted communities in successfully navigating contract services, leading to fiscally responsible solu...

admission and continued stay reviews according to the Utilization Review Plan diagnostic criteria. Works closely with the... to include pre-certification, admissions reviews, and continued stay reviews. Work with Medical Records regarding documents sent...

. Verifies member information and reviews prescriber/provider requests for specialty drug administration location of care via... preferred. Post-service reviews or Appeals reviews preferred. Experience working with specialty drugs strongly preferred...

and training materials. Conduct quality reviews to ensure accuracy, completeness, and timely processing. Identify workflow...

credit risk reviews of various lending portfolios to provide an independent assessment of the Bank's quality of credit...

Description : Responsibilities Include: Contract reviews - review and revise contracts improving or eliminating...

field and in an office setting. The Program Manager conducts site visits scheduled and unannounced and performs desk reviews... processes. They will also be expected to participate in RFP proposal reviews as necessary by the agency COMMUNITY COORDINATOR...

of Act 250 applications. Coordinates daily activities of a District Office. Recommends, plans, installs, reviews...

perspective on workplace flexibility. Candidates must work in Central Time zone. Position Purpose: Performs concurrent reviews... necessity and setting of care being delivered to the member. Performs concurrent reviews of member for appropriate care...

and persons in our care. - Conduct full reviews of memos, letters, reports. - Conducting inter-agency collaboration..., or management audits, including reviews of Electronic Data Processing (EDP) systems. - Planning and overseeing the development...

and/or Compact State Licensure required Behavioral and Mental Health Medical Necessity Criteria Reviews for IN BH Medicaid Worked... authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance...

guidelines. Design and own credit assessment methodologies, lead and participate in comprehensive credit risk reviews of various... stakeholders across all lines of defense, represent CRR, own and effectively deliver conclusions of CRR reviews with clarity...

review and provide clearance on potential negative news alerts for new clients or during periodic client reviews. Perform... prospect client reviews and provide recommendations prior to onboarding prospects as well as other referrals from line units...

conducts real-time secondary reviews on invoices for contracted services provided by DSS/HRA/DHS. SIRT aims to identify... DHS/HRA Fiscal manuals and Standard/ Enhanced Invoice Review Policies as guidance. - Present findings of invoice reviews...