Actalent is hiring a Utilization Management Nurse! Job Description The Utilization Management Nurse (UMN... using standardized Review Criteria. Coordinate with the Medical Director/Physicians for requests outside standard Review...
to authorize services and appropriately identify and refer requests to the Medical Director when indicated. Utilization Management... for completing medical necessity reviews. Using clinical knowledge and experience, the Utilization Management Review Nurse reviews...
Role Overview: Under the direction of a supervisor, the Clinical Care Reviewer – Utilization Management evaluates..., cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral...
, Utilization Management evaluates medical necessity for inpatient and outpatient services, ensuring treatment aligns with clinical... Management will also be counted upon to: Conduct utilization management reviews by assessing medical necessity, appropriateness...
Position Purpose This position consistently applies the utilization management process as required by CMS including... the use of designated criteria for primary review. Incorporates into the utilization management process the ability...
organization. Create an equitable work environment. About the Role The Level I Utilization Management Clinician performs... utilization review for medical or behavioral health requests using utilization review criteria, technologies, and tools...
of high risk, and under and overuse of services. Collaborates with Medical Director and senior management on complex cases... previous experience in Managed Care Utilization Management, Medical Management, Case Management. Preferred: Two (2) years...
clinical review determinations. The Utilization Management Nurse, Senior will report to the Manager, Utilization and Medical...Job Category: Healthcare Services and Operations Job Description: Your Role The Utilization Management Prior...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines...
and a responsibility to better the public good. CoreCivic is currently seeking a Utilization Management/ Case Management Nurse located..., TN office location. The Utilization Management/Case Management Nurse provides Utilization Review and Case Management...
benefits and the additional medical, community, or financial resources available. Provide utilization management (UM) services... to Large Case Reinsurance RN and Care Management team as appropriate. Assist Medical Director in developing guidelines...
and apply medical necessity criteria in order to determine the appropriate level of care. Resource/Utilization Management...Description Summary: The Utilization Management Nurse II is responsible for determining the clinical...
and apply medical necessity criteria in order to determine the appropriate level of care. Resource/Utilization Management...Description Summary: The Utilization Management Nurse III is responsible for determining the clinical...
Requires practical knowledge of Utilization Management functions including prior authorization/concurrent review Requires...Job Category: Customer Services and Operations Job Description: Your Role The Behavioral Health (BH) Utilization...
Role Overview: Under the direction of a supervisor, the Clinical Care Reviewer – Utilization Management evaluates..., cases are escalated to the Medical Director for further review. The reviewer independently applies medical and behavioral...
as needed with the utilization management physician advisors and/or medical directors on problematic cases and documents his decisions...Job Category: Revenue_Cycle Job Description: Under broad direction from the Centralized Utilization Management...
) admission in the acute setting. Works with UM leadership, including the Utilization Management Medical Director, on requests... between acute care facilities. Acts as a department resource for medical service requests/referral management and processes...