We have other current jobs related to this field that you can find below

  • Utilization Review Nurse

    6 days ago

    Columbia, Maryland, United States Johns Hopkins Medicine Full time

    Position OverviewThe Utilization Review Nurse plays a critical role in ensuring the quality and efficiency of patient care. This position is integral to the Utilization Management team, reporting directly to the Manager of Utilization Management.Key ResponsibilitiesConduct thorough reviews of medical records to assess utilization and quality of care.Engage...

  • PRN Utilization Review Nurse

    3 weeks ago

    Columbia, United States Johns Hopkins Medicine Full time

    Apply Refer a Friend Back Share This Page Share on Facebook Share on Twitter Share on LinkedIn Share via Email Job Details Requisition #: 643356 Location: Johns Hopkins Howard County Medical Center, Columbia, MD 21044 Category: Nursing Schedule: Day ShiftYou deserve more... As a member of Johns Hopkins Medicine, Johns Hopkins Howard County Medical...

  • Clinical Utilization Review Coordinator

    17 hours ago

    Columbia, Missouri, United States Lexington Medical Center Full time

    Department: Utilization ManagementPosition Type: PRNShift: RotatingSchedule: Variable About Lexington Medical Center: Consistently recognized as a leading healthcare provider, Lexington Medical Center is dedicated to delivering exceptional health services tailored to the needs of our communities. As the top-ranked hospital in the Columbia metro area by U.S....

  • Utilization Review Specialist

    3 weeks ago

    West Columbia, United States Lexington Medical Center Full time

    Utilization Management Dept. PRN Rotating variable Consistently named best hospital, Lexington Medical Center dedicates itself to providing quality health services that meet the needs of its communities. Ranked #1 in the Columbia metro area by U.S. News & World Report, Lexington Medical Center is the only hospital named one of the Best Places to Work in...

  • Healthcare Utilization Review Analyst

    6 days ago

    Columbia, Missouri, United States Lexington Medical Center Full time

    Department: Utilization ManagementEmployment Type: PRNShift: RotatingSchedule: VariableAbout Lexington Medical Center: Consistently recognized as a leading healthcare provider, Lexington Medical Center is dedicated to delivering exceptional health services tailored to the needs of our communities. As the top-ranked hospital in the Columbia metro area...

  • Medical Consultant

    2 weeks ago

    Columbia, United States CAPITOL BRIDGE, LLC Full time

    POSITION DESCRIPTION: The Medical Consultant will be responsible for the retrospective review of Medicare denials for Part A inpatient hospital stays under the Alexander vs. Azar ruling to determine eligibility for appeal. This position will solely support the scope of work for the Eligibility Contractor period of performance only. The period of...

  • Client Account Review Specialist

    10 hours ago

    Columbia, South Carolina, United States The McDaniel Corporation Full time

    Position OverviewWe are seeking a Client Account Review Specialist to support our financial planning firm in delivering outstanding service to our clients. This role is crucial in ensuring the accuracy and integrity of client accounts.Key Responsibilities:Develop and enhance financial presentations utilizing Excel to convey essential information.Conduct...

  • Commissioning Engineer for Clean Utilities

    6 days ago

    Columbia, South Carolina, United States Cloud Staffing Professionals Full time

    Position: Clean Utilities Commissioning/Validation Engineer (CQV) Company Overview: Cloud Staffing Professionals is a prominent Contract Development and Manufacturing Organization (CDMO) focused on advanced therapies, including cell culture and gene therapy solutions. We are currently seeking a Clean Utilities Commissioning/Validation Engineer with practical...

  • Clinical Utilization Analyst

    14 hours ago

    Columbia, Missouri, United States Lexington Medical Center Full time

    Department: Utilization ManagementSchedule: PRNShift: RotatingHours: Variable About Lexington Medical Center: Consistently recognized as a leading healthcare provider, Lexington Medical Center is dedicated to delivering high-quality medical services tailored to the needs of the community. It is ranked #1 in the Columbia metro area by U.S. News & World Report...

  • Speech and Language Clinician

    6 days ago

    Columbia, South Carolina, United States InsideHigherEd Full time

    Position Title: Speech PathologistDepartment: Brain Health ServicesEmployment Type: Full TimeSalary Information: Competitive Salary OfferedAbout the InstitutionThe University of South Carolina system is dedicated to enhancing the lives of individuals across South Carolina through its diverse educational offerings and community engagement initiatives.With...

  • Utilization Management Coordinator

    2 months ago

    West Columbia, United States Universal Health Services Full time

    Responsibilities At Three Rivers Behavioral Health, a 129 bed facility located in West Columbia, SC, we never forget that patients are people -- people with potential, who can have better relationships and live more productive lives. For those who seek a secure environment, healing, hope, treatment, and recovery, Three Rivers is the first place for a second...

  • Program Supervisor

    1 month ago

    Columbia, United States Amtec Direct Hire Full time

    Job DescriptionJob DescriptionPOSITION SUMMARY:The incumbent in this position shall be responsible for the oversight of a wide variety of projects or assignments, including those that are large, strategic, or complex in nature, in the field of water and wastewater engineering and construction. This includes all aspects of public and private water supply...

  • LPN Clinical Patient Services Coordinator

    3 months ago

    Columbia, United States Amedisys Full time

    OverviewLPN License RequiredResponsible for scheduling the home visits for the field staff and assisting with the coordination of patient care. Works under the direction of the Clinical Manager to ensure the proper utilization of clinical resources to maximize care center capacity and utilization guidelines. Responsible for scheduling and communicating with...

  • Registered Nurse

    3 days ago

    Columbia, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference.Job SummaryThis position provides coding and utilization analysis for Homecare patients and clinical staff. This job requires analytical skills and close attention to detail. All team members are expected to be knowledgeable and compliant with Prisma Health's values of compassion, dignity,...

  • Registered Nurse

    4 days ago

    COLUMBIA, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference.Job SummaryThis position provides coding and utilization analysis for Homecare patients and clinical staff. This job requires analytical skills and close attention to detail. All team members are expected to be knowledgeable and compliant with Prisma Health's values of compassion, dignity, excellence,...

  • Registered Nurse

    4 days ago

    COLUMBIA, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference.Job SummaryThis position provides coding and utilization analysis for Homecare patients and clinical staff. This job requires analytical skills and close attention to detail. All team members are expected to be knowledgeable and compliant with Prisma Health's values of compassion, dignity, excellence,...

  • LPN Clinical Patient Services Coordinator

    2 months ago

    Columbia, United States Amedisys Full time

    Overview LPN License Required Responsible for scheduling the home visits for the field staff and assisting with the coordination of patient care. Works under the direction of the Clinical Manager to ensure the proper utilization of clinical resources to maximize care center capacity and utilization guidelines. Responsible for scheduling and communicating...

  • Cloud Support Engineer for Utility Systems

    12 hours ago

    Columbia, South Carolina, United States Peraton Full time

    Key ResponsibilitiesPeraton is seeking a Cloud Systems Engineer specializing in Utility Operations to contribute to our Cyber Mission sector. In this role, you will provide essential systems engineering support for a significant enterprise-wide engineering initiative within the Intelligence Community. This position requires a commitment of 1880 hours...

  • Registered Nurse

    3 days ago

    Columbia, SC, United States Prisma Health Full time

    Inspire health. Serve with compassion. Be the difference. Job Summary This position provides coding and utilization analysis for Homecare patients and clinical staff. This job requires analytical skills and close attention to detail. All team members are expected to be knowledgeable and compliant with Prisma Health's values of compassion, dignity,...

  • Manager Advanced Practice Clinician

    3 weeks ago

    Columbia, United States Optum Full time

    Job DescriptionManager Advanced Practice Clinician - North Carolina and South Carolina Optum Home & Community Care, part of the UnitedHealth Group family of businesses, is creating something new in health care. We are uniting industry-leading solutions to build an integrated care model that holistically addresses an individual’s physical, mental and...

Utilization Review Clinician

2 months ago

Columbia, United States Centene Corporation Full time

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Performs a clinical review and assesses care related to mental health and substance abuse. Monitors and determines if level of care and services related to mental health and substance abuse are medically appropriate. Evaluates member’s treatment for mental health and substance abuse before, during, and after services to ensure level of care and services are medically appropriate Performs prior authorization reviews related to mental health and substance abuse to determine medical appropriateness in accordance with regulatory guidelines and criteria Performs concurrent review of behavioral health (BH) inpatient to determine overall health of member, treatment needs, and discharge planning Analyzes BH member data to improve quality and appropriate utilization of services Provides education to providers members and their families regrading BH utilization process Interacts with BH healthcare providers as appropriate to discuss level of care and/or services Engages with medical directors and leadership to improve the quality and efficiency of care Formulates and presents cases in staffing and integrated rounds Performs other duties as assigned Complies with all policies and standards Education/Experience: Requires Graduate of an Accredited School Nursing or Bachelor's degree and 2 – 4 years of related experience. License to practice independently, and/or have obtained the state required licensure as outlined by the applicable state required. Master’s degree for behavioral health clinicians required. Clinical knowledge and ability to review and/or assess treatment plans related to mental health and substance abuse preferred. Knowledge of mental health and substance abuse utilization review process preferred. Experience working with providers and healthcare teams to review care services related to mental health and substance abuse preferred. License/Certification: LCSW- License Clinical Social Worker required or LMHC-Licensed Mental Health Counselor required or LPC-Licensed Professional Counselor required or Licensed Marital and Family Therapist (LMFT) required or Licensed Mental Health Professional (LMHP) required or RN - Registered Nurse - State Licensure and/or Compact State Licensure required Location: Position is 100% remote. Prefer candidate to live in Central or Eastern Time Zone. Pay Range: $25.97 - $46.68 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.