Current jobs related to Clinical Utilization Review Specialist - Ridgeland, Mississippi - Telligen

  • Senior Clinical Operations Manager

    6 days ago

    Ridgeland, Mississippi, United States (336610) Medical Services of America Home Health Full time

    About the RoleWe are seeking an experienced Registered Nurse to serve as our Senior Clinical Operations Manager for our Home Health location in Ridgeland, SC. The estimated salary for this role is $80,000 - $100,000 per year, depending on experience.Key ResponsibilitiesApprove requests for services, re-certifications, add-on orders, and changes to ensure...

  • Audit Professional

    1 month ago

    Ridgeland, Mississippi, United States Gpac Full time

    Audit ProfessionalGpac is seeking a highly motivated and detail-oriented Audit Professional to join their team. As an Audit Professional, you will be responsible for supporting the accounting and auditing teams in daily functions, reviewing and preparing audits, and completing timely audits and submitting reports. You will also be responsible for handling...

  • Senior Review Coordinator

    2 months ago

    Ridgeland, United States Telligen Full time

    The Review Coordinator will be responsible for performing utilization review/medical management including prospective, concurrent, and retrospective reviews for all services.Essential Functions:Provides independent review decision for prospective, concurrent or retrospective utilization review/medical management cases. Cases can consist of inpatient,...

  • Senior Review Coordinator

    3 weeks ago

    Ridgeland, United States Telligen Full time

    The Review Coordinator will be responsible for performing utilization review/medical management including prospective, concurrent, and retrospective reviews for all services.Essential Functions: Provides independent review decision for prospective, concurrent or retrospective utilization review/medical management cases. Cases can consist of inpatient,...

  • Loan Review Analyst II

    4 weeks ago

    Ridgeland, United States BankPlus Full time

    At BankPlus, we strive to add value for our employees, customers and shareholders. We are a high-performing TEAM committed to fulfilling promises, building lasting relationships, and making dreams come true. All current employees must have a performance rating of Outstanding or High-Performing to be eligible to post for a position. General Position Scope:...

  • Hospice Clinical Liaison Specialist

    4 weeks ago

    Ridgeland, South Carolina, United States FC Compassus LLC Full time

    Job SummaryThe Hospice Clinical Liaison is responsible for promoting the Compassus philosophy and values, utilizing the 6 Pillars of Success as a foundation. This role involves upholding the Code of Ethical Conduct and fostering positive working relationships within the company, among departments, and with external stakeholders. The Hospice Clinical Liaison...

  • Clinical Liaison Specialist

    4 weeks ago

    Ridgeland, South Carolina, United States Compassus Full time

    Hospice Clinical LiaisonCompassus is seeking a skilled Clinical Liaison to join our team. In this role, you will be responsible for promoting the Compassus philosophy and upholding our values of Compassion, Integrity, Excellence, Teamwork, and Innovation. You will work closely with referral sources, hospitals, and facilities to identify patients who may...

  • Pest Specialist

    1 month ago

    Ridgeland, United States Palmetto Exterminators Full time

    Job DescriptionJob DescriptionGROWING PEST CONTROL COMPANY LOOKING TO HIRE FULL TIME PEST SPECIALISTSWe are currently seeking motivated career minded individuals to join our team. Please only apply if you are a serious applicant looking to expand your experience in this career field. No experience is required to apply for this position as we offer paid...

  • Clinical Manager RN Home Health

    4 weeks ago

    Ridgeland, United States (336610) Medical Services of America Home Health Full time

    Job DescriptionJob DescriptionMSA Home Health, a proud member of the Medical Services of America family is currently seeking an experienced Registered Nurse to join our team as the Clinical Manager for our Home Health location in Ridgeland, SC.Responsibilities include:Approves requests for services, re-certifications, add-on orders and changes.Overseas the...

  • Consumer Loan Sales Specialist

    4 days ago

    Ridgeland, United States OneMain Financial Full time

    At OneMain, Consumer Loan Sales Specialists empower customers listening to their needs and providing access to friendly, fast, and affordable financing for lifes expenses. Consumer Loan Sales Specialist will learn the lending and servicing business at OneMain allowing them to grow their career. In the Role Deliver results related to individual and branch...

  • Behavior Technician

    2 weeks ago

    Ridgeland, United States Sevita Full time

    Bright Light, a part of the Sevita family, provides center-based Applied Behavioral Analysis (ABA) services to individuals with Autism Spectrum Disorder and related disabilities.Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate...

  • Behavior Technician

    1 month ago

    Ridgeland, United States Sevita Full time

    Bright Light, a part of the Sevita family, provides center-based Applied Behavioral Analysis (ABA) services to individuals with Autism Spectrum Disorder and related disabilities.Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate...

  • Behavior Technician

    2 weeks ago

    Ridgeland, United States Sevita Full time

    Bright Light, a part of the Sevita family, provides center-based Applied Behavioral Analysis (ABA) services to individuals with Autism Spectrum Disorder and related disabilities.Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You'll join a mission-driven team and create relationships that motivate...

  • Behavior Technician

    3 weeks ago

    Ridgeland, United States Sevita Full time

    Bright Light, a part of the Sevita family, provides center-based Applied Behavioral Analysis (ABA) services to individuals with Autism Spectrum Disorder and related disabilities.Here we believe every person has the right to live well, and everyone deserves to have a fulfilling career. You’ll join a mission-driven team and create relationships that motivate...

  • Administrative Specialist

    3 weeks ago

    Ridgeland, United States McCalla Raymer Leibert Pierce, LLC Full time

    SUMMARY: This position includes but is not limited to supporting 3 attorneys with administrative matters including filing of case, incoming and outgoing mail, copying, scanning, etc. This position may include certain tasks associated with e-filing bankruptcy related legal documents, updating client and internal case management systems, and reviewing...

  • Administrative Specialist

    3 weeks ago

    Ridgeland, United States McCalla Raymer Leibert Pierce, LLC Full time

    SUMMARY: This position includes but is not limited to supporting 3 attorneys with administrative matters including filing of case, incoming and outgoing mail, copying, scanning, etc. This position may include certain tasks associated with e-filing bankruptcy related legal documents, updating client and internal case management systems, and reviewing...

  • Event Sales Representative

    2 months ago

    Ridgeland, United States Comcast Full time

    Comcast brings together the best in media and technology. We drive innovation to create the world's best entertainment and online experiences. As a Fortune 50 leader, we set the pace in a variety of innovative and fascinating businesses and create career opportunities across a wide range of locations and disciplines. We are at the forefront of change and...

  • Senior Staff Accountant

    2 weeks ago

    Ridgeland, United States AIS Healthcare Full time

    AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care...

  • Event Sales Representative

    2 months ago

    Ridgeland, United States Comcast Full time

    Comcast brings together the best in media and technology. We drive innovation to create the world's best entertainment and online experiences. As a Fortune 50 leader, we set the pace in a variety of innovative and fascinating businesses and create career opportunities across a wide range of locations and disciplines. We are at the forefront of change and...

  • Event Sales Representative

    2 weeks ago

    Ridgeland, United States Comcast Full time

    Comcast brings together the best in media and technology. We drive innovation to create the world's best entertainment and online experiences. As a Fortune 50 leader, we set the pace in a variety of innovative and fascinating businesses and create career opportunities across a wide range of locations and disciplines. We are at the forefront of change and...

  • Social Worker/Volunteer Coordinator

    2 months ago

    Ridgeland, United States Compassus Full time

    CompanyCompassusPosition SummaryThe Social Worker and Volunteer Coordinator is responsible for modeling the Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation and for promoting the Compassus philosophy, using the 6 Pillars of Success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for...

  • Staff Accountant

    2 weeks ago

    Ridgeland, United States AIS HealthCare Full time

    AIS Healthcare is the leading provider of Targeted Drug Delivery (TDD) and Infusion Care. With our diverse culture, and our values around Innovation, Stewardship, and Unity, we are committed to Advancing Quality, and Improving Lives. We are dedicated to doing more for our patients by providing quality products and services that enhance the entire care...

Clinical Utilization Review Specialist

1 month ago

Ridgeland, Mississippi, United States Telligen Full time

The Clinical Utilization Review Specialist will be responsible for performing comprehensive reviews of healthcare services to ensure they are medically necessary and meet contract requirements.

Key responsibilities include:

  • Conducting prospective, concurrent, and retrospective reviews of inpatient, outpatient, procedure, DME, and therapy services
  • Ensuring quality of care meets contract, state, or URAC requirements
  • Collaborating with peer reviewers, providers, facilities, and subscribers to resolve review decisions
  • Documenting medical information supporting decisions into the workflow documentation system

Requirements include:

  • 3-5 years experience in nursing in a clinical environment
  • Knowledge of medical coding and billing is preferred
  • Experience working in an insurance or managed care environment is preferred

Telligen is a leading population health management organization committed to improving health and economies. We're looking for talented individuals who share our values of Ownership, Community, Ingenuity, and Integrity.

As a Clinical Utilization Review Specialist, you will play a critical role in ensuring the quality of care meets our high standards. If you're passionate about healthcare and committed to excellence, we encourage you to apply.