Clinical Utilization Reviewer

Job SummaryThe Clinical Utilization Reviewer is responsible for reviewing and making decisions about the appropriateness and level of beneficiary care being provided to ensure cost-effective care and proper utilization of resources.Key ResponsibilitiesConducts prior authorization, continued stay, and referral management activities.Assesses medical necessity...

Job Title: Clinical Utilization Review SpecialistJoin Centene Corporation, a leading healthcare company, as a Clinical Utilization Review Specialist. In this role, you will play a critical part in ensuring the quality and appropriateness of care for our 28 million members.Job Summary:We are seeking a highly skilled Clinical Utilization Review Specialist to...

About UsNeuroPsychiatric Hospital is a leading healthcare provider with a unique approach to neuropsychiatric and complex medical care. With a strong focus on interdisciplinary collaboration, our facilities offer unrivaled quality care to patients across the United States.Job OverviewWe are seeking a skilled Utilization Review Coordinator to join our team....

About Us:Healing the Body and Mind:NeuroPsychiatric Hospital is a leading healthcare provider with a unique approach to neuropsychiatric and complex medical care. Founded 15 years ago, we have established ourselves as the largest hospital system in the nation, serving patients with both neurological and medical needs.Our Mission:We strive to provide...

Job Title: Utilization Review Authorization SpecialistThe Utilization Review Authorization Specialist is a critical role at Sanctuary Recovery Centers, responsible for ensuring timely and appropriate care for our patients. This position requires strong communication and organizational skills, as well as a deep understanding of healthcare regulations and...

Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical team, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary costs.Key ResponsibilitiesApply critical thinking and clinical expertise to review and authorize...

Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our utilization management team, you will play a critical role in ensuring that our patients receive the highest quality care while minimizing unnecessary costs.Key ResponsibilitiesApply critical thinking and clinical expertise to review...

Job SummaryCVS Health is seeking a skilled Clinical Utilization Management Consultant to join our team. As a key member of our healthcare team, you will play a critical role in ensuring the delivery of high-quality, patient-centered care.Key ResponsibilitiesApply critical thinking and clinical expertise to review and authorize medical services and...

Job Title: Clinical Utilization ManagerCVS Health is seeking a highly skilled Clinical Utilization Manager to join our team. As a key member of our Behavioral Health department, you will play a critical role in coordinating, documenting, and communicating all aspects of the utilization/benefit management program for preauthorization of mental health...

Mobile Research Nurse Job DescriptionWe are seeking a skilled and compassionate nurse with a passion for clinical research to join our dynamic team as a Mobile Research Nurse. As a key member of our team, you will play a crucial role in ensuring the successful execution of research studies.Key Responsibilities:Administer investigational medications/products...

Mobile Research NurseWe are seeking a skilled and compassionate nurse with a passion for clinical research to join our dynamic team as a Mobile Research Nurse. This role plays a crucial part in ensuring the successful execution of research studies, providing high-quality clinical care to patients/participants, and adhering to study protocols with utmost...

Job SummaryWe are seeking a highly skilled Clinical Reviewer to join our team at TriWest Healthcare Alliance. As a Clinical Reviewer, you will play a critical role in ensuring the medical necessity of procedures and services for our members.Key ResponsibilitiesConduct medical necessity reviews using InterQual Clinical Guidelines and Clinical Decision Support...

Pharmacy Utilization Management RoleWe're a fully licensed health insurer, Medix™, dedicated to making healthcare simple, transparent, and human. Our goal is to create a healthcare experience that's intuitive and puts people, not cost or workflows, first.We're changing how health insurance works by using a consumer-focused and tech-driven approach. This...

Optum Clinical Document Improvement SpecialistAt Optum, we're dedicated to delivering care that improves health outcomes for millions of people around the world. As a Clinical Document Improvement Specialist, you'll play a critical role in ensuring that our clients' patients receive accurate and comprehensive documentation that reflects their clinical...

Job Title: Certified Pharmacy TechnicianWe're a fully licensed health insurer, Medix™, and we're changing how health insurance works by creating a healthcare experience that's intuitive and puts people, not cost or workflows, first.In this role, you will play an essential part in building our pharmacy utilization management function. The Clinical Review...

Job SummaryWe are seeking a highly skilled Registered Nurse to join our Utilization Management team at the Phoenix VA Healthcare System. As a key member of our team, you will play a pivotal role in ensuring optimal patient care through admission and continued stay reviews for inpatients.ResponsibilitiesConduct thorough medical record reviews to identify the...

Job SummaryThis position is located within the GEC Utilization Management, Nursing Service at the Phoenix VA Healthcare System in Phoenix, AZ.Key ResponsibilitiesEnsure optimal patient care through admission and continued stay reviews for inpatients.Utilize National Utilization Management Integration software package in conjunction with VHA and local...

Job Title: Document ReviewerWe are seeking a skilled Document Reviewer to join our team at KLDiscovery. As a Document Reviewer, you will play a critical role in supporting our clients' litigation needs by reviewing and coding documents for relevancy, confidentiality, and privilege.Key Responsibilities:Review and code documents using electronic review...

Job SummaryCVS Health is seeking a highly skilled Oncology and Transplant Utilization Management Nurse Consultant to join our team. As a key member of our clinical team, you will work in a clinical telephone queue, collaborating with providers to secure additional information for prior authorization reviews. Your clinical expertise will be utilized to...

Job SummaryCVS Health is seeking a highly skilled Utilization Management Nurse Consultant to join our team. As a key member of our clinical team, you will work closely with providers to secure additional information for prior authorization reviews, utilizing your clinical expertise to coordinate, document, and communicate all aspects of the...