and cost effective care delivery. What You’ll Be Doing: Performs utilization review of outpatient procedures and ancillary... potential cases for Care Management programs Collaborates with physicians and other providers to facilitate provision...
is looking for a Clinical Reviewer - LPN/LVN or RN (Remote U.S.) to join our growing team. Job Summary: Review medical records...+ years of Utilization Review/Management (UR/UM) and/or Prior Authorization. 2+ years of knowledge of medical necessity...
required. Utilization Management experience preferred. Comprehensive knowledge and experience with managed care benefit plans. Ability... and appeals as indicated in support of a high performing health plan and physician network. The Clinical Reviewer will investigate...
JOB SUMMARY Under the leadership of the Manager of Quality and Safety, the Clinical Quality Reviewer (CQR... and understanding of patient care. Be skilled in understanding and interpreting clinical data. The ability to successfully communicate...
, case management or utilization management related experience. Knowledge of current standards of care to be followed... guidelines to render precertification determinations as described in the Medical Management UM work plan. This detailed clinical...
accurate administration of benefits, execution of clinical policy, timely access to appropriate levels of care and provision... to manage utilization within the benefit plan. Responsible for the review of grievance and appeal cases referred for clinical...
validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care; and assumes chief... opportunities for clinical quality improvement and other special projects as may be identified. To perform this job successfully...
in earning supplemental income while maintaining their clinical practice. Position Details Specialty: Pain Management... provider of Utilization Review (UR) services, is expanding its expert physician panel. We are currently seeking Board-Certified...
Overview: Medical Reviewer III - Managed Care Project (MCP) - REMOTE The Medical Reviewer III (MCP...) will be responsible for conducting clinical reviews of medical records for the Medicaid Managed Care Project (MCP). Applies Medicaid...
Seeking a Board-Certified Physician to serve as an Onsite Physician Advisor supporting Care Management and Clinical...: Utilization Management (20%) Lead the Utilization Review Committee in collaboration with the Care Management Director Perform...
: Under the general direction of the Director of Care Management, performs criteria-based concurrent and retrospective utilization... with patient care management; comply with applicable standards and regulations and provide information and education to clinical...
are to be documented in patient medical record and shared with managed care organizations when requested. Assesses for best utilization... regarding level of patient care, diagnostic testing, and clinical procedures without jeopardizing patient quality efforts...
Job Summary and Responsibilities Under the general direction of the Director of Care Management, performs criteria-based... quality patient care; assist with patient care management; comply with applicable standards and regulations and provide...
3 years of clinical nursing experience At least 2 years of experience in utilization management of sub-acute Medicare..., facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. Document review outcomes...
3 years of clinical nursing experience At least 2 years of experience in utilization management of sub-acute Medicare..., facilities, and interdisciplinary teams to ensure optimal patient care and resource utilization. Document review outcomes...
and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license. Conducts pre...-certification, concurrent review, and appeals of Behavioral Health OP services. Mentors Behavioral Health Care Management staff...
. Knowledge of current disease/care management/coordination trends is preferred Technical Skills: Must have the ability...Maternal Nurse Reviewer/ Contract - Jericho or Albany, NY (#25288) Location: Jericho or Albany, NY Employment...
Summary Acts as Team Lead for specialty programs, medical review, utilization management, and case management areas... clinical, OR Two years clinical and two years medical review/utilization review, OR, combination of health plan, clinical...
. Knowledge of current disease/care management/coordination trends is preferred Technical Skills: Must have the ability...Maternal Nurse Reviewer/ Contract - Jericho or Albany, NY (#25288) Location: Jericho or Albany, NY Employment...
) Authorize, direct and monitor care for behavioral health and/or substance abuse problems according to clinical information given... with network practitioners to provide education on best practice models and utilization management processes Interact with the...