- CareFirst (Baltimore, MD)
- **Resp & Qualifications** **PURPOSE:** Utilizing key principles of utilization management , the Utilization Review Specialist will perform prospective, ... (all benefits/incentives are subject to eligibility requirements). **Department** Clinical Utilization Management **Equal Employment Opportunity** CareFirst BlueCross… more
- Kelsey-Seybold Clinic (Houston, TX)
- …needs **Job Title: Utilization Review Specialist (LVN)** **Location: Remote ** **Department:** ** Utilization Management ** **Job Type: Full Time** ... **Responsibilities** The Utilization Review Specialist (LVN) is responsible for conducting medical reviews, benefit verification, and applying criteria to… more
- Fairview Health Services (St. Paul, MN)
- **Overview** M Health Fairview has an immediate opening for a Utilization Management Specialist RN. This is a 1.0 FTE (80 hours per two week pay period), ... related to denials/appeals. + Educate internal members of the health care team on utilization management workflow and managed care concepts. + Work on a variety… more
- Spectrum Billing Solutions (Skokie, IL)
- …cycle management company for healthcare organizations. We are looking to add a Utilization Review (UR) Specialist to our growing team. The UR Specialist ... in working in a cohesive and rewarding environment. This is a remote or office/home hybrid position. Responsibilities include: + Review patient admission and… more
- AdventHealth (Altamonte Springs, FL)
- …cause and bring about the best opportunity for fair reimbursement. The Clinical Denial Management Specialist will adhere to the AHS Compliance Plan and to all ... rebilling. . Collaborates with pre-access, patient financial services, revenue integrity, utilization management and clinical department staff to obtain further… more
- St. Luke's University Health Network (Allentown, PA)
- …serve, regardless of a patient's ability to pay for health care. The Denials Management Specialist reviews inpatient CMS and third party denials for medical ... billing with information needed to obtain payment of claims. Remote within local geography after orientation. JOB DUTIES AND...+ Prefer minimum of 2-5 years' experience in case management and/or utilization management . +… more
- Sanford Health (MN)
- …- 28.00 **Department Details** Opportunity to work remotely. **Job Summary** Monitors the utilization of resources, risk management and quality of care for ... to the work of health and healing across our broad footprint.** **Facility:** Remote MN **Location:** Remote , MN **Address:** **Shift:** Day **Job Schedule:**… more
- Intermountain Health (Murray, UT)
- …role that combines the expertise of a Licensed and Masters Prepared Behavior Health Specialist with Utilization and Care management . This role is essential ... in care management /navigation or closely related field including: Utilization Management , discharge planning, managed care, health promotion, health… more
- Merck (Providence, RI)
- …strategic goals, aligning closely with broader business objectives. + **Technology Utilization :** + Leverage global trade management systems, including SAP ... **Job Description** **Job Title:** Senior Specialist , Trade Operations (Band 400, P3) **Department:** Global...400, P3) **Department:** Global Clinical Supply Compliance Operations **Location:** Remote Work, however, can be Required at Rahway or… more
- Ochsner Health (New Orleans, LA)
- …Preferred - Certification in Case Management (CCM) or Certified Professional in Utilization Review, Utilization Management or Health Care Management ... of patient care as an RN. Experience in Case Management , Utilization Review and/or Discharge Planning .either...work from the following areas are not eligible for remote work position_ _: Colorado, California, Hawaii, Maryland, New… more