Clinical Utilization Review Specialist

Company OverviewRising Medical Solutions is dedicated to transforming the healthcare landscape by enhancing the efficiency of healthcare claims through comprehensive bill review, case management, and utilization review. Position SummaryWe are currently seeking a qualified Utilization Review Nurse to join our team. This full-time role requires a commitment of...

Responsibilities POSITION OVERVIEW:Conducts prompt and regular clinical evaluations across various payer categories to obtain approvals for both initial and ongoing treatment in alignment with payer guidelines and the comprehensive Utilization Management Plan of the organization. Acts as a point of contact for external reviewers, efficiently managing the...

Company: Oak Street Health Title: Full-Time Utilization Management Physician Reviewer Location: Remote/ Treehouse Role Overview: This full-time position is dedicated to delivering precise and prompt coverage decisions for both inpatient and outpatient services by utilizing utilization management (UM) criteria, clinical expertise, and established internal...

Dane Street, LLC, recognized as a certified "Great Place to Work," is seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday work week while adhering to client-mandated turnaround times.Physician...

Job SummaryWe are seeking a highly skilled Quality Utilization Specialist to join our team at Northwestern Memorial Healthcare. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care and optimal resource utilization in our Emergency Department.Key ResponsibilitiesApply medical necessity criteria,...

Dane Street, LLC, recognized as a certified "Great Place to Work," is actively seeking Board Certified Internal Medicine physicians to engage in Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a conventional Monday to Friday workweek while adhering to client-mandated turnaround...

Dane Street, LLC, recognized as a certified "Great Place to Work," is actively seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday workweek while adhering to client-mandated turnaround...

Job SummaryThe Central Intake Clinical Specialist is a key member of The Alden Network team, responsible for clinically reviewing patient referrals in a timely manner and responding promptly to the referral source with an acceptance or denial. This role is focused on census development by expediting the timeliness of acceptances and increasing the volume of...

At Health Care Service Corporation (HCSC), our workforce is the foundation of our operations and the key to our achievements. We equip our team members with tailored development strategies that encourage advancement and support rewarding, meaningful careers. Position Overview This role is accountable for conducting initial and ongoing review processes;...

At Health Care Service Corporation, our workforce is integral to our mission and the key to our achievements. We equip our team members with tailored development strategies that encourage advancement and support rewarding, meaningful careers. Position Overview This role entails conducting initial and ongoing review processes; coordinating discharge care to...

At Health Care Service Corporation, our workforce is the foundation of our operations and the key to our achievements. We equip our team members with tailored development plans that encourage advancement and foster rewarding, fulfilling careers. Position Overview This role is pivotal in executing initial and ongoing review processes, as well as coordinating...

About the RoleDane Street, LLC is seeking a Board Certified Internal Medicine physician to conduct Independent Medical Exams (IMEs) and Peer Reviews. As a medical reviewer, you will utilize your clinical expertise to review disability claims and provide an interpretation of the medical appropriateness of services provided by other healthcare...

Dane Street, LLC, recognized as a certified "Great Place to Work," is actively seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday workweek while adhering to client-mandated turnaround times.As...

Dane Street, LLC, recognized as a certified "Great Place to Work," is seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday work week while adhering to client-mandated turnaround times.As a...

Dane Street, LLC, recognized as a certified "Great Place to Work," is seeking Board Certified Internal Medicine physicians to perform Independent Medical Exams (IME) and Peer Reviews. This role offers the flexibility to tailor your schedule and caseload within a standard Monday to Friday workweek while adhering to client-mandated turnaround times.As a...

Job OverviewRedgrave LLP, a premier law firm recognized for its excellence in eDiscovery and Information Governance, is seeking experienced attorneys to join our dynamic team. Our firm is dedicated to providing top-tier legal services focused on Information Law, encompassing eDiscovery, data governance, privacy, and security.Position HighlightsWe are looking...

At Insight Hospital and Medical Center, we are committed to redefining quality healthcare while striving for health equity. Our organization is dedicated to collaborating with the community to establish a comprehensive hospital that addresses the needs of our residents. With a passionate team focused on delivering exceptional service, our mission is to...

About AbbottAbbott is a prominent leader in the healthcare sector, dedicated to enhancing the quality of life through innovative medical solutions. Our extensive range of transformative technologies encompasses diagnostics, medical devices, nutritionals, and branded generic medicines. With a workforce of 114,000 professionals, we serve individuals across...

Healthcare Utilization Analyst Northwestern Memorial Healthcare is in search of a Healthcare Utilization Analyst to enhance our team. The successful candidate will utilize medical necessity evaluation criteria, care level protocols, and nursing expertise to guarantee suitable admissions and hospital stay durations. Effective collaboration with insurance...

Job SummaryAramark is seeking a skilled Clinical Nutrition Specialist to provide interim support in a long-term care setting. The ideal candidate will have a passion for delivering high-quality nutritional services to seniors.Key ResponsibilitiesConduct comprehensive nutrition assessments to identify and address acute and chronic conditions.Develop and...