- Monte Nido (Miami, FL)
- …lives while providing the opportunity for people to realize their healthy selves. ** Utilization Review Clinician ** **Monte Nido** **Remote** **Monte Nido has ... to provide comprehensive care within an intimate home setting. We are seeking a Utilization Review Clinician to join our team. This is a fully remote role… more
- Centene Corporation (Jefferson City, MO)
- …and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and ... or EST time zone with experience in mental health settings and utilization management / review . **Position Purpose:** Performs a clinical review and assesses… more
- Centene Corporation (Tallahassee, FL)
- …assess ABA Treatment Plans preferred. Knowledge of ABA services and BH utilization review process preferred. Experience working with providers and healthcare ... Analyzes BH member data to improve quality and appropriate utilization of services + Interacts with BH healthcare providers...teams to review care services related to Applied Behavior Analysis Services… more
- Centene Corporation (Columbus, OH)
- …RESIDE IN STATE OF OHIO **Position Purpose:** Performs a post-service retrospective review of member medical records and assessing care related to behavioral health ... cost efficiency and within compliance. + Performs a post-service retrospective review of member's medical records provided against guidelines to determine if… more
- Point32Health (MA)
- …Point32Health, click here (https://youtu.be/S5I\_HgoecJQ) . **Job Summary** Provide behavioral health utilization review and care management in order to ensure ... plans of treatment. Work as a member of one of the Concurrent Review Team. **Key** **Responsibilities/Duties** **- what you will be doing** Coordinate the delivery… more
- CVS Health (Denver, CO)
- …* Knowledge of mental health and substance abuse disorders * Managed care/ utilization review experience * Crisis intervention skills * Position requires ... opportunities to promote quality effectiveness of healthcare services and benefit utilization * Consults and lends expertise to other internal and external… more
- CVS Health (Harrisburg, PA)
- …such as ambulatory care or outpatient program + Managed care and utilization review experience preferred. + Crisis intervention skills preferred. **Education** ... skills to coordinate, document and communicate all aspects of the utilization /benefit management program. Applies critical thinking and is knowledgeable in… more
- WMCHealth (West Nyack, NY)
- HC QA-Coding Review Clinician Company: Good Samaritan Hospital Home Care City/State: West Nyack, NY Category: Home Health Department: HH Quality Assurance Union: ... Details: Summary: The Home Care Quality Assurance and Coding Review Clinician is responsible for assisting the...OASIS accuracy issues. + Performs quality improvement measures and utilization review of medical records under the… more
- Kepro (Indianapolis, IN)
- …issues. + A strong knowledge of Quality Assurance (QA) and Utilization Review (UR). + A contemporary clinician who understands major trends in healthcare ... experience or Quality Assurance committee responsibility in a hospital setting. + Utilization Management (UM) review experience. + Experience as a physician… more
- Molina Healthcare (New York, NY)
- …for Medicaid .** **We are looking for a RN Care Review Clinician with Prior Authorization experience. Candidates with Utilization Management (UM) and ... experience are highly preferred. Additional experience with appeals, quality review , and experience with data collection/reports.** **_Bilingual candidates that… more