, ensuring quality and inter-rater reliability, overseeing audit readiness, and chairing Integra’s Utilization Management... and renewals. Committee Leadership & Governance Chair the Utilization Management Committee, ensuring compliance with regulatory...
utilization management, medical management and/or quality management, and/or call center experience; or any combination...(s) required. Preferred Skills, Capabilities, and Experiences: Familiarity with Utilization Management Guidelines, ICD-10 and coding...
of prior utilization management, medical management and/or quality management, and/or call center experience... in applicable state(s) required. Preferred Skills, Capabilities, and Experiences: Familiarity with Utilization Management...
or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management...: Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS...
of the utilization management team. We can offer you a meaningful way to make a difference in patients lives, in a non... utilization management determination process. Job Description Reviews charts and analyzes clinical record documentation...
, attending utilization management rounds, and serving on interdepartmental initiatives; assists in developing a program...Anticipated End Date: 2026-02-04 Position Title: Psychologist Reviewer - Georgia Job Description: Psychologist...
to provide education on best practice models and utilization management processes Interact with the Medical Director... Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh...
by assisting in training, attending utilization management rounds, and serving on interdepartmental initiatives; assists...Anticipated End Date: 2026-02-09 Position Title: Psychologist Reviewer - part time Job Description: Work location...
or hospital setting or minimum of 1 year of prior utilization management, medical management and/or quality management...: Familiarity with Utilization Management Guidelines, ICD-9 and CPT-4 coding, and managed health care including HMO, PPO and POS...
balance, continuous learning, and career development. Summary We are seeking a talented individual for a Nurse Reviewer... need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined...
balance, continuous learning, and career development. Summary We are seeking a talented individual for a Nurse Reviewer... need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined...
testing requests Interact with network practitioners to provide education on best practice models and utilization management... Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh...
assurance auditors for multiple review types including Place of Service, Level of Care, Readmissions, Utilization Management... Nurse Reviewer, Sr. Specialist who is responsible for performing on-going quality assurance audits of the work performed...
Job Description: Dental Hygienist Reviewer / Contract - Downstate, NY (#25303) Location: Downstate, New York... that align with their skills and career goals. Position Overview: We are seeking an experienced Dental Hygienist Reviewer...
assurance auditors for multiple review types including Place of Service, Level of Care, Readmissions, Utilization Management... Nurse Reviewer, Sr. Specialist who is responsible for performing on-going quality assurance audits of the work performed...
, 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...
Overview: Medicare Medical Review RN (Medical Reviewer III) - REMOTE The Medicare Medical Review RN (Medical... Reviewer III) will primarily be responsible for conducting clinical reviews of medical records during the course of fraud...
is looking for a Medical Reviewer - Psychiatrist - Must be Licensed in Arkansas - PRN (Remote within the U.S.) to join our growing team.... Job Summary: The Psychiatrist takes on a crucial role by providing clinical leadership for peer and utilization review...
Reviewer Doctor of Dental Surgery (DDS) OR Doctor of Medicine in Dentistry (DMD) - PRN will oversee Utilization Management... Dental Utilization Management program. Collaborate with the State Medical Director or Program Director on case consultations...
Overview: Medical Reviewer III - Managed Care Project (MCP) - REMOTE The Medical Reviewer III (MCP... years’ utilization/quality assurance review and ICD-10-CM/CPT-4 coding experience At least 4 years’ experience in coding...