Utilization Review Nurse Liaison

About the Job:We are seeking a highly skilled Utilization Review Nurse to join our team at US Tech Solutions. As a key member of our organization, you will be responsible for reviewing documentation and evaluating Potential Quality of Care issues based on clinical policies and benefit determinations. You will work closely with internal/external clinicians to...

Your Opportunity:US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. As a Nurse Utilization Reviewer - Clinical Policy, you will be responsible for reviewing documentation and interpreting data obtained from clinical records or systems to apply appropriate clinical criteria and...

Company OverviewPrime Healthcare is an equal employment opportunity employer, striving to create a diverse and inclusive work environment. We prioritize providing opportunities for professional growth and development while upholding a commitment to quality patient care.Estimated SalaryFor this RN Assessment Coordinator role, the estimated annual salary is...

We are seeking a highly skilled Medical Group Liaison Specialist to join our team at w3r Consulting. This is a dynamic position that requires strong analytical, verbal, and written communication skills.About the JobAs a Medical Group Liaison Specialist, you will be responsible for ensuring compliance with utilization management (UM) and quality review (QR)...

Job SummaryWelcome to Guidehealth, a data-powered healthcare company dedicated to operational excellence. We are seeking an experienced Registered Nurse with a passion for utilization review and patient care. As a Nurse Utilization Specialist, you will play a vital role in ensuring that our clients receive high-quality, cost-effective care while maintaining...

Job Overview:Elevance Health is seeking a skilled Nurse Reviewer to join our team. As a key member of our healthcare team, you will play a vital role in conducting preauthorization reviews for diagnostic imaging services.Key Responsibilities:Collaborate with healthcare providers and members to ensure the most appropriate use of diagnostic imaging...

Clinical Review Nurse Job DescriptionWe are seeking a highly skilled Clinical Review Nurse to join our team in the Insurance industry in Chicago, Illinois.Job SummaryThis role involves reviewing patient charts to ensure compliance with standards of care. The ideal candidate will have experience with medical record review and be able to apply structured...

Key ResponsibilitiesParticipate in the development and implementation of QM Work Plan activities.Review and evaluate complex data and information sets to identify trends and areas for improvement.Collaborate with internal/external clinician support teams to coordinate clinical resolution.Prepare and complete QM documents based on interpretation and...

Salary and BenefitsThe estimated salary for this position is $114,000 per year, paid bi-weekly. In addition to a competitive compensation package, we offer comprehensive Medical, Dental, and Vision plans to keep you covered. We also provide Life and Disability insurance for your peace of mind and an Employee Assistance Program (EAP) to support you through...

Elevance Health seeks a skilled Clinical Review Specialist to join our team. As a valued member of our organization, you will play a critical role in ensuring the quality and efficiency of healthcare services. Your primary responsibilities will include conducting medical necessity reviews for diagnostic imaging procedures and out-of-network services,...

ResponsibilitiesWe are seeking an experienced Collector and Liaison to manage aged accounts receivable, including contacting clients to collect past due invoices and resolving underlying issues.The successful candidate will review, research, and resolve all client receivables, work collaboratively with other members of the Billing & Collections team to...

About UsLa Rabida Children's Hospital is a leading pediatric hospital in Chicago, IL, dedicated to providing high-quality care to children with complex conditions, disabilities, and chronic illnesses.Job DescriptionWe are seeking a highly skilled Care Management and Utilization Leader to join our team at La Rabida Children's Hospital in Chicago, IL. This is...

Company OverviewAt Energy Infrastructure Partners LLC, we are dedicated to designing and implementing cutting-edge solutions that promote resource efficiency, renewable energy, and sustainability. Our core focus lies in fostering meaningful partnerships with organizations, government agencies, stakeholders, and utility commercial and industrial customers.Job...

Job OverviewWe are seeking a skilled Clinical Utilization Specialist to join our team. In this role, you will play a vital part in reviewing and evaluating Utilization Management (UM) plans for prospective and existing Medical Groups/IPAs in the HMO networks.Key Responsibilities:Reviews UM/QR plans to ensure compliance with HMO standards and...

Otolaryngology Specialist Job Summary">This 1099 contractor position is fully remote, and we are seeking a skilled Physician Reviewer to join our team as a Medical Director/ Otolaryngology Specialist. The successful candidate will be responsible for reviewing medical necessity requests and providing determinations.">About the Ideal Candidate:">The ideal...

About Elevance Health: We are a healthcare company dedicated to improving lives and communities through innovative solutions and compassionate care. Our mission is to make healthcare simpler and more accessible to our members and the communities we serve.">Job Summary: We are seeking a skilled Clinical Reviewer I-5 to join our team and conduct...

Streamlining Healthcare OperationsAs an ED Utilization Review/Case Manager at Insight Hospital and Medical Center, you will play a crucial role in optimizing patient flow and resource utilization.This position requires a deep understanding of healthcare operations and the ability to communicate effectively with various stakeholders, including healthcare...

Utilization Management SpecialistAbout the Role:This position involves working closely with medical groups and IPAs to ensure compliance with utilization management and quality review functions. The ideal candidate will have strong analytical and communication skills, as well as experience in utilization review, quality assurance, or statistical research.

About the RoleWe are looking for a Clinical Review Consultant to join our team at Centene Corporation. As a key member of our Behavioral Health department, you will be responsible for reviewing and authorizing care for individuals struggling with behavioral health and substance abuse issues.Key ResponsibilitiesYour primary duties will include conducting...

Job SummaryUtilizing clinical expertise, our physicians review disability claims by providing an interpretation of the medical appropriateness of services provided by other healthcare professionals in compliance with state regulations and guidelines, nationally recognized evidence-based guidelines, client-specific policies, procedures, performance standards,...