- AmeriHealth Caritas (Southfield, MI)
- …us at www.amerihealthcaritas.com. **Responsibilities:** Under the direction of a supervisor, the Clinical Care Reviewer , Utilization Management evaluates ... benchmarks, and efficiency metrics in a fast-paced environment. ;The Clinical Care Reviewer , Utilization...and quickly.; + Strong understanding of utilization review processes, including medical necessity criteria, care … more
- Adelante (Goodyear, AZ)
- …health outcomes reporting, clinical audits, and programmatic evaluation + Help evaluate clinical care , utilization of resources, and development of new ... Clinical Registered Dietitian II - Goodyear Job Details...for assessing the nutritional status and developing evidence-based nutrition care plans for patients across the lifespan with various… more
- US Tech Solutions (Canton, MA)
- …possible extension)** Notes: Fully remote, MA license required.** **Job Summary The Clinical Reviewer is a licensed professional -a Registered Nurse preferred- ... for managing a clinically complex caseload of varied requests for services. The Clinical Reviewer is responsible for making the determination of medical… more
- Blue Cross Blue Shield of Massachusetts (Hingham, MA)
- …and benefits, as well as regulatory and NCQA requirements. + Refer to RN or PT Clinical Utilization reviewer for more complex cases as appropriate or when ... with emphasis on utilization management, discharge planning, care coordination, clinical outcomes, and quality of... clinical information to support the medical necessity review process and plan of care . +… more
- AmeriHealth Caritas (Charleston, SC)
- …**Responsibilities:** Under the direction of the Supervisor, the Behavioral Health Utilization Management Reviewer is responsible for completing medical ... all information necessary to perform a thorough medical necessity review . It is within the BH UM Reviewer...of behavioral health and substance use disorder experience.; + Utilization management experience in a managed care … more
- Aspen Medical (Aurora, CO)
- …experience in a direct patient care clinical setting. Must have utilization management, utilization review or case management experience for 12 ... (HCQM) through American Board of Quality Assurance and Utilization Review Physicians (ABQARP), Certified Informatics Nursing, Ambulatory Care Nursing,… more
- Excellus BlueCross BlueShield (Rochester, NY)
- …the diagnosis and treatment of members' medical health conditions, applying established clinical review criteria, guidelines and medical policies and contractual ... as well as State and Federal Mandates. May perform clinical review telephonically, electronically, or on-site, depending...policy and procedure, identifies and refers potential quality of care and utilization issues to Medical Director.… more
- AnMed Health (Anderson, SC)
- … Review Medical Director supports operations and direction of the Care Coordination, Clinical Documentation, and Utilization Management programs at ... consultation to the leadership and staff who perform the functions of Utilization Management (UM), Case Management (CM), Transition Planning/ Discharge Planning, and… more
- HCA Healthcare (Alexandria, LA)
- …you passionate about delivering patient-centered care ?** Submit your application for RN Clinical Reviewer PRN position and spend more time at the bedside ... **Description** **Rapides Regional Medical Center** **RN Clinical Reviewer ** **PRN** Rapides Regional Medical...Nurse + Registered Nurse Diploma, or Associate Degree + Utilization Review and coding experience preferred +… more
- Centers Plan for Healthy Living (Margate, FL)
- …currently accepting applications for Full Time Registered Nurse without experience. The Utilization Management Clinical Reviewer works within a ... in their home to improve their quality of life. Utilization Management Clinical Reviewer will...care managers and believe that coordinating high quality clinical and social services will result in better … more