services setting Expertise and experience in addressing the needs of the Long Term Services and Support population... more about us at www.amerihealthcaritas.com. Responsibilities: Under the direction of the Long Term Services and Supports (LTSS...
with utilization management nurses and clinical staff to support timely decision-making. Review appeals and grievances related... clinical and operational management services and market expansion initiatives for Managed Medicaid, Medicare Advantage, Special...
Job Description: The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring... to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse...
The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services... necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse Reviewers collaborate...
Anticipated End Date: 2026-01-31 Position Title: Utilization Management Rep II Job Description: Utilization... as required by law. The Utilization Management Representative II is responsible for managing incoming calls, including triage, opening...
Anticipated End Date: 2025-11-28 Position Title: Utilization Management Representative... I Job Description: Utilization Management Representative I Virtual: This role enables associates to work virtually full-time, with the exception...
support in clinical decision-making oversight and physician level guidance in quality management, utilization management..., and care management. The Physician reviewer supports all IEHP departments in meeting the regulatory requirements set forth...
Immediate need for a talented Psychologist Reviewer. This is a 12 Months Contract opportunity with long-term potential.... Interact with network practitioners to provide education on best practice models and utilization management processes...
, Psychosocial Rehabilitation, Intensive Outpatient Treatment, Day Treatment, Mental Health Support Services and ABA Services... and consistent utilization of plan benefits, out of network services, and clinical guidelines within scope of license. Conducts pre...
clinical and operational management care populations, and risk-adjusted entities. We support organizations as they navigate... Determinations Conduct thorough, timely medical reviews for utilization management, appeals, grievances, and other clinical...
and style standards, reference libraries, reviewer guidelines, and quality control tools/measures. Manages the utilization..., short- and long-term disability, business accident insurance, and group legal insurance. Subject to the terms...
such as Independent Technical Reviewer, as required. Oversee risk management related to projects and pursuits including review... and accidental death & dismemberment (AD&D) insurance, short-term/long-term disability plans, emergency travel benefits, tuition...
(e.g., med-surg, telemetry, ICU) At least 1 year of experience in utilization review, case management, or hospital... (Voluntary Life & AD&D for the employee and dependents) Short and long-term disability Health Spending Account (HSA...
Job Description: The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring... to determine the necessity and appropriateness of medical procedures, tests, and treatments. Utilization Management Nurse...
, chart reviews, medical necessity, appropriateness of care and return to work, short and long-term disability, Family..., DO, with an excellent understanding of network services and managed care, appropriate utilization of services and credentialing, quality...
, appropriateness of care and return to work, short and long-term disability, Family and Medical Leave Act (FMLA), Group health... services and managed care, appropriate utilization of services and credentialing, quality assurance and the development...