Clinical Utilization Manager
3 weeks ago
Kris Anderson Consulting, LLC is seeking a skilled Clinical Utilization Manager to join our team. As a Clinical Utilization Manager, you will be responsible for implementing and coordinating all utilization management functions relating to pre-certification of outpatient services.
Key Responsibilities- Clear understanding of managed healthcare, utilization management
- Possess knowledge of applicable regulatory standards and is able to prepare for audits based upon these standards
- Ability to maintain compliance and turnaround time standards for all UM assignments
- Provide excellent customer service to our members
- Communicate effectively with a professional attitude
- Be responsible and accountable for all assignments and deliverables
- Follow company policies, procedures and directives
- Interact in a positive and constructive manner
- Prioritize and multitask in a fast-paced work environment
- Inputs all information in referral system and ensures that all information is accurate.
- Process referral authorization from providers in a timely manner, by utilizing established protocols.
- Faxes back to requested provider information needed if not received.
- Gathers and assess relevant documentation to compare with MCG/UM Criteria.
- Communicates with Utilization Physician Reviewer for follow-up and resolution of authorization referrals.
- Interacts effectively with providers, physician reviewers, and other departments using strong verbal and written communication skills on an on-going basis
- Applies UM criteria appropriately to authorization requests
- Apply Timeliness Standards to processing of referrals (ICE Timelines Grids)
- Review and update authorizations as needed
- Requests medical records or other information as needed to justify referrals
- Other duties as assigned
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Clinical Review Nurse
3 weeks ago
Dallas, Texas, United States AmTrust Financial Full timeJob SummaryWe are seeking a skilled Clinical Review Nurse to join our team at AmTrust Financial Services. As a Clinical Review Nurse, you will play a critical role in reviewing medical necessity, appropriateness, quality, and efficiency of services for Workers' Compensation claimants.Key ResponsibilitiesPerform utilization review activities prospectively,...
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Clinical Utilization Review Nurse
2 weeks ago
Dallas, Texas, United States UT Southwestern Medical Center Full timeJob SummaryUT Southwestern Medical Center is seeking a skilled Registered Nurse to join our Utilization Review team. As a Utilization Review Registered Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care, while also promoting efficient use of healthcare resources.Key ResponsibilitiesConduct medical...
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Utilization Management Nurse
4 weeks ago
Dallas, Texas, United States Parkland Health & Hospital System Full timeAbout the RoleParkland Health & Hospital System is seeking a skilled Utilization Management Nurse to join our team. As a Utilization Management Nurse, you will play a critical role in ensuring that our members receive the most appropriate and effective care possible.Key ResponsibilitiesPerform utilization review activities, including pre-certification,...
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Pet Care Manager
2 weeks ago
Dallas, Texas, United States LLFO PET MANAGER LLC Full timeJob OverviewWe are seeking a highly motivated and experienced Pet Care Manager to join our team at LLFO PET MANAGER LLC. As a key member of our management team, you will be responsible for ensuring the highest standards of pet care and customer service in our Dogtopia store.Key ResponsibilitiesPet Care and SafetyMaintain a clean and safe environment for our...
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Utilization Review Nurse
1 week ago
Dallas, Texas, United States Children's Health Full timeJob Title: Utilization ReviewrnAt Children's Health, our mission is to Make Life Better for Children for 110 years, and generation to come. We recognize that their health plays a crucial role in achieving this goal.Through our cutting-edge treatments and affiliation with UT Southwestern, we strive to deliver an extraordinary patient and family experience,...
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Clinical Research Coordinator
1 month ago
Dallas, Texas, United States ALLIANCE CLINICAL LLC Full timePosition OverviewJob Summary: The Clinical Research Assistant plays a crucial role in supporting clinical studies by ensuring compliance with protocols and maintaining high standards of patient interaction.Key Responsibilities:1) Adhere to all organizational policies and ethical guidelines.2) Maintain strict confidentiality and compliance with regulatory...
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Clinical Research Associate
1 week ago
Dallas, Texas, United States C-Clinical at Dallas Full timeJob Title: Clinical Research Associate - CNSC-Clinical at Dallas is seeking a highly skilled Clinical Research Associate (CRA) to join our team. As a CRA, you will be responsible for managing clinical trials, ensuring compliance with regulatory requirements, and providing exceptional customer service to our clients.Responsibilities:Manage clinical trials...
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Clinical Trials Research Associate
1 month ago
Dallas, Texas, United States ALLIANCE CLINICAL LLC Full timePosition OverviewJob Summary: The Clinical Research Assistant plays a vital role in the execution of clinical trials, ensuring adherence to protocols and regulatory standards.Key Responsibilities:1) Uphold all organizational policies and ethical standards.2) Maintain strict confidentiality and compliance with all regulations.3) Engage effectively and...
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Clinical Call Representative
5 days ago
Dallas, Texas, United States CRU Fortrea Clinical Research Unit Inc. Full timeTransforming Clinical Trials with Passion and PrecisionAt CRU Fortrea Clinical Research Unit Inc., we're driven by a passion for scientific rigor and a commitment to transforming drug and device development for partners and patients worldwide. As a leading global contract research organization, we offer a wide range of clinical development, patient access,...
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Clinical Research Associate
2 weeks ago
Dallas, Texas, United States C-Clinical at Dallas Full timeJob OpportunityC-Clinical at Dallas is seeking a highly skilled Clinical Research Associate (CRA) to join our team. As a CRA, you will play a critical role in ensuring the success of our clinical trials by monitoring sites, managing data, and collaborating with study teams.ResponsibilitiesMonitor clinical sites to ensure compliance with study protocols and...
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Clinical Care Manager RN
4 weeks ago
Dallas, Texas, United States CVS Health Full timeJob SummaryCVS Health is seeking a skilled Clinical Care Manager RN to join our team. As a Clinical Care Manager RN, you will play a critical role in delivering high-quality healthcare services to our members.Key ResponsibilitiesDevelop and implement health service strategies, policies, and programs to drive quality healthcare delivery to our members.Utilize...
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Clinical Informatics Manager
2 weeks ago
Dallas, Texas, United States Baylor Scott & White Health Full timeJob SummaryThe Clinical Informatics Manager provides strategic leadership and direction to various departments, committees, and councils to assess current state practices, processes, and content, and to standardize and streamline to best practice. This role will work closely with the Baylor Scott & White Health (BSWH) Information Systems (IS) team to...
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Wet Utility Project Manager
2 weeks ago
Dallas, Texas, United States Michael Page Full timeJob Title: Wet Utility SuperintendentMichael Page is seeking an experienced Wet Utility Superintendent to lead our high-profile commercial projects in the DFW area.About the Role:As a Wet Utility Superintendent, you will be responsible for overseeing daily field operations to ensure proper site safety, construction progress, quality control, and a clean...
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Senior Clinical Research Associate
1 week ago
Dallas, Texas, United States C-Clinical at Dallas Full timeJob OverviewC-Clinical at Dallas is a clinical operations partner that provides highly specialized consulting services for the pharmaceutical, biotechnology, and device industries. We are seeking a Senior Clinical Research Associate (CRA) to join our team in a CNS role.ResponsibilitiesInterface with the study team to ensure timely initiation and completion...
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Utilization Review Nurse
2 days ago
Dallas, Texas, United States UT Southwestern Medical Center Full timeJob SummaryUT Southwestern Medical Center is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that patients receive the most appropriate level of care while minimizing unnecessary hospital stays.Key ResponsibilitiesConduct medical certification reviews for medical necessity...
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Nurse Utilization Review Specialist
2 weeks ago
Dallas, Texas, United States Children's Health Full timeJob Title: Utilization Review NurseChildren's Health is seeking a skilled Utilization Review Nurse to join our team. As a Utilization Review Nurse, you will play a critical role in ensuring that our patients receive the most appropriate and effective care.Responsibilities:Conduct thorough reviews of patient records to determine medical necessity and...
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Senior Utility Operations Manager
3 weeks ago
Dallas, Texas, United States Michael Page Full timeAbout the RoleWe are seeking a highly experienced and skilled Senior Utility Operations Manager to lead our high-profile commercial projects in the DFW area.Key ResponsibilitiesLead daily field operations to ensure site safety, construction progress, quality control, and a clean site.Develop a comprehensive understanding of project strategy, commitments, and...
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Clinical Call Representative
1 month ago
Dallas, Texas, United States CRU Fortrea Clinical Research Unit Inc. Full timeAt CRU Fortrea Clinical Research Unit Inc., we are a leading contract research organization dedicated to advancing clinical development through scientific excellence and innovation. Our team of professionals operates globally, driving advancements in drug and device development.About the Role:Handle inbound and outbound calls with potential study...
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Clinical Care Manager RN
2 weeks ago
Dallas, Texas, United States Nursing Solutions Full timeJob Title: Clinical Care Manager RNWe are seeking a highly skilled and compassionate Clinical Care Manager RN to join our team at Nursing Solutions. As a Clinical Care Manager RN, you will be responsible for providing exceptional patient care and leading a team of healthcare professionals to deliver high-quality services.Job Summary:The Clinical Care Manager...
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Clinical Care Manager RN
2 days ago
Dallas, Texas, United States Nursing Solutions Full timeJob Title: Clinical Care Manager RNWe are seeking a highly skilled and compassionate Clinical Care Manager RN to join our team at Nursing Solutions. As a Clinical Care Manager RN, you will be responsible for providing exceptional patient care and ensuring the highest level of quality and safety in our pediatric home health services.Job Summary:The Clinical...