(UM) nurse (must have California license) to join the remote, utilization management, pre-service team. As a UM Nurse...Overview of the Role: Alignment Health is seeking a collaborative and tech savvy RN / LVN utilization management...
(must have California license) to join the remote, utilization management, pre-service team. As a UM Nurse, you will review requests for pre...Utilization Management (UM) Nurse - Pre-Service (Must have RN / LVN California Licensure) Location: Remote...
Under general direction: The Utilization Management RN serves as a leader resource in the Utilization Management... compliance. The UM RN conducts initial concurrent and retrospective medical necessity reviews. All Utilization Management...
Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical Review. In this role...Job Description: Your Role The Utilization Management Prior Authorization team processes accurate and timely prior...
Caring. Connecting. Growing together. HCBS Utilization Management Nurse Position requires a District of Columbia RN License.... This role works under the direct supervision of the DC Associate Director of Utilization Management Function is responsible...
setting required. Appeals and Grievances experience or PCS Utilization experience New York State license as Registered Nurse...Remote Utilization Management Nurse Care Manager – 2 positions * Experience working with Personal Care Services (PCS...
Anticipated End Date: 2025-01-03 Position Title: Utilization Management Nurse Job Description: The Utilization... Management Nurse is responsible to collaborate with healthcare providers and members to promote quality member outcomes...
Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for all lines... on Utilization Management including concurrent reviews and prior authorizations Utilization Management concurrent review and prior...
testing is current. Admission procedures or appeals are communicated to insurance carriers via telephonic/fax/on-line review... you for your understanding! ** Utilizes clinical knowledge, payor contracts, medical review policies, supporting research, and any...
for Utilization Review. Position: Registered Nurse Department: Denial/Appeal Administrator Schedule: Monday- Friday, evenings... addition to Utilization Review, to validate the patient’s placement to be at the most appropriate level of care based...
Job Family: Clinical Appeals Nurse Travel Required: None Clearance Required: None What You Will Do: The Remote... Clinical Denials/Appeals Nurse will be directly responsible for securing pre-service approvals, and reviewing pre/post service...
of denials, utilization review, or case management experience strongly preferred Other Knowledge, Skills and Abilities... between healthcare providers for any additional medical documentation or clarification, and submitting appeals in a timely manner...
**At this time, only registered nurses with prior Utilization Review or Appeals experience will be considered... for services provided. Collaborates with physicians, Utilization Review RN's, Case Managers, revenue cycle personnel and payers...
with Utilization Review is also key. The Appeals coordinator must be proficient in evidence based clinical screening criteria, MCG...Job Summary: The Appeals Coordinator is responsible for the review, response (including appeals), and trending...
, including a minimum of two years in a grievance and appeals or related area such as medical or utilization management...Overview Resolves grievances, appeals and external reviews for one of the following VNS Health Plans product lines...
position to all audiences Performs other duties as assigned Position: UM Outpatient Clinical Review Nurse /Utilization...Purpose Contributes to the overall success of the Utilization Management department by performing clinical reviews...
description and/or job title. Positions in this function require various nurse licensure and certification based on role and grade level... team for review (e.g., Medicare, Medicaid, Commercial) -Validate that cases/requests for services require additional...
search of a highly motivated candidate to join our talented Team. Job Title: Clinical Medical Review Nurse Location...(s): Baltimore, MD The Clinical Medical Review Nurse handles day to day review of professional and institutional claims...
the medical records for Medicare Appeals. Many of our nurses find case review to be an intellectually rewarding position... authorizations, chart review, utilization review with Durable Medical Equipment required 2 years of clinical experience...
continuum for assigned patient populations. This position primarily focuses on Utilization Management activities... and/or InterQual criteria Prompt and effective management of payer denials and appeals Collaboration and consultation with secondary...