Clinical Utilization Manager

About UsProvidence is a not-for-profit network of medical centers, physician groups, and clinics that provide a full spectrum of care to patients across the United States. Our mission is to serve everyone, especially the poor and vulnerable, with dignity and compassion.Job SummaryWe are seeking a Clinical Utilization Management Specialist to join our team in...

About the Role:We are seeking a skilled Clinical Utilization Review Specialist to join our team. As a key member of our Revenue Cycle department, you will play a vital role in ensuring the accurate and efficient management of patient care.Key Responsibilities:Conduct thorough clinical reviews of medical records to ensure compliance with health plans and...

Job Summary:This position is responsible for conducting thorough clinical reviews of medical records to ensure compliance with health plans and regulatory requirements.Key Responsibilities:Determine medical necessity and provide recommendations for treatment plans.Collaborate with healthcare providers and payers to resolve utilization review issues.Provide...

Job OverviewThis position offers a unique opportunity to work in a remote utilization review setting, conducting clinical reviews and medical necessity determinations for patients across various payers. As a skilled Utilization Review RN, you will be responsible for ensuring the most appropriate level of care is provided to our patients while maintaining...

Job ResponsibilitiesWe are seeking a skilled Utilization Review RN to join our team, responsible for:Conducting clinical reviews and medical necessity determinations for patients across various payersEnsuring compliance with regulatory requirements and health plan guidelinesCollaborating with multidisciplinary teams to provide comprehensive care...

Key ResponsibilitiesManage and facilitate clinical education for new hires and existing clinical staff.Support Utilization Management with a focus on new hire training and continuing education for Blue Shield of California clinicians working concurrent review and prior authorizations.Conduct training classes in a virtual learning environment and at times in...

Your Role The Medical Care Solutions education team is responsible for all clinical education for all departments within Medical Care Solutions as well as some Health Solutions teams. This includes Utilization Management, Care Management, Post Service, and Appeals. This clinical educator role will be responsible for Utilization Management for all lines of...

Job Title: Clinical Utilization SpecialistAbout Emonics LLC:Emonics LLC is a reputable healthcare organization that offers outpatient services. Our team consists of experienced professionals dedicated to delivering high-quality care.Salary:$85,000 - $110,000 per year (based on experience)About the Job:We are seeking a skilled Registered Nurse for our...

Utilization Review RN *Part-time/Days* at Providence summary: As a Utilization Review RN at Providence, I conduct clinical reviews for inpatient admissions, ensuring compliance with medical necessity guidelines while maintaining patient-centered care. This part-time role demands a strong clinical background and experience in Utilization Management to...

Description Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management,...

Description Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization Management,...

Description Provide prospective, retrospective, and concurrent utilization reviews for our LA ministries. Conduct clinical reviews and review medical records daily during admission for all payers, as required by the health plans. This role requires a strong clinical background combined with well-developed knowledge and skills in Utilization...

Overview:We are seeking a skilled RN to join our team as a Utilization Review Specialist. This role is responsible for reviewing medical records and determining the necessity of treatments and services.Responsibilities:The ideal candidate will have 3 years of clinical experience in hospital or urgent care settings, with knowledge of ICD10, CPT, and HCPC...

Key Responsibilities">Manage patient flow, triage, and direct patient care.Liaise between front desk staff, nursing staff, physicians, and clinic manager.Develop expected patient outcomes, define appropriate resource utilization, and work with providers to set patient goals.Provide nursing support/coordination to optimize patient outcomes and improve patient...

Job ResponsibilitiesAs a Clinical Utilization Manager, you will be responsible for:Providing prospective, retrospective, and concurrent utilization reviews for our LA ministries.Conducting clinical reviews and reviewing medical records daily during admission for all payers, as required by the health plans.Effectively and efficiently managing a diverse...

Your Role The Utilization Management Prior Authorization team ensures accurate and timely prior authorization of designated healthcare services, continuity or care, and access to care clinical review determinations. The Manager, Utilization and Medical Review will report to the Sr. Manager, Utilization and Medical Review. In this role you will be managing a...

Job Title: Heavy Civil Utilities ManagerWe are seeking a dedicated professional to oversee various heavy civil utilities-related tasks and support the completion of construction projects. About the Role:The ideal candidate will manage sewer and storm utilities for highway, bridge, demolition, and concrete paving projects. Key responsibilities include...

The Per Diem Clinical Care Coordinator RN plays a vital role in the delivery of quality patient care, focusing on communication and coordination among patients, caregivers, and healthcare professionals. This position requires a California Registered Nurse License, with a preference for candidates holding a Bachelor's or Master's Degree in Nursing and case...

Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination. Providence caregivers are...

Description Care Management is a collaborative practice model including the patients, nurses, social workers, physicians, other practitioners, caregivers and the community. The care management process encompasses excellent communication, both verbal and written, and facilitates care along a continuum through effective resource coordination. Providence...