Utilization Review Nurse Specialist

Job SummaryWe are seeking a skilled RN Case Manager to join our team at Arkansas Heart Hospital. As a RN Case Manager, you will be responsible for utilizing the nursing process to assess, plan, and evaluate the care of a designated case load of patients. Your primary responsibility will be to oversee Care Coordination and Utilization Review for all patients,...

Job Overview Position Summary Key Responsibilities Community Engagement: Acquire and apply comprehensive knowledge of program standards within designated service areas, including but not limited to: PASSE systems, HCBS, DDS, DCFS. Maintain an up-to-date understanding of all operational procedures related to Community Supports (CS). Foster and sustain...

About the RoleCNSI, a leading healthcare technology and services company, is seeking a highly skilled Dental Physician Reviewer to join our team. As a key member of our Utilization Management (UM) team, you will play a critical role in ensuring the delivery of high-quality healthcare services to our clients.Key ResponsibilitiesOversee utilization/management...

About the RoleWe are seeking a highly skilled Dental Physician Reviewer to join our team at Acentra Health. As a key member of our Utilization Management program, you will play a critical role in ensuring the highest quality of care for our clients.Key ResponsibilitiesOversee utilization/management activities, including peer review, utilization review, fair...

Job Details Description Primary Responsibilities and Duties Community Support Engagement: Acquire and apply comprehensive knowledge while ensuring compliance with program standards in designated areas. Maintain an up-to-date understanding of all operational procedures related to Community Supports. Foster and sustain positive relationships with community...

Job SummaryThe Clinical Pharmacist - Utilization Management will play a crucial role in ensuring the effective management of pharmacy benefits and services for our members. This position requires a strong understanding of pharmacy practices, medical policies, and regulatory requirements.Key ResponsibilitiesConduct second-level reviews for medical and...

Job SummaryThe Clinical Pharmacist - Utilization Management will report to and operate under the direction of Pharmacy leadership, working cooperatively and sometimes independently with medical directors and others within the Enterprise.ResponsibilitiesConducts second-level reviews for medical and pharmacy benefit medication prior-authorizations, exceptions,...

Job SummaryThe Clinical Pharmacist - Utilization Management will report to and operate under the direction of Pharmacy leadership and will also be expected to work cooperatively and sometimes independently with all medical directors and others within the Enterprise.ResponsibilitiesConducts the second level review for medical and pharmacy benefit medication...

Job SummaryThe Clinical Pharmacist - Utilization Management will report to and operate under the direction of Pharmacy leadership and will also be expected to work cooperatively and sometimes independently with all medical directors and others within the Enterprise.ResponsibilitiesConducts the second level review for medical and pharmacy benefit medication...

Wellspring Nurse Source is seeking a skilled travel nurse RN oncology professional for a travel nursing assignment.Job Details:Specialty: OncologyDiscipline: Registered Nurse (RN)Employment Type: Travel NursingShift: 12 hours, nightsHours per Week: 36About the Assignment:As a travel nurse RN oncology specialist with Wellspring Nurse Source, you will have the...

Job Summary:This is a first-level position in the Coding Department at BHMC-Little Rock. The successful candidate will obtain a basic knowledge of coding resources, including 3M 360. They will review clinical documentation and apply appropriate billing and diagnostic codes using accepted guidelines. The individual will work towards achieving a high level of...

Job OverviewPosition SummaryThe Utilization Specialist plays a crucial role in ensuring effective resource management and community support. This position involves maintaining a comprehensive understanding of program standards and fostering collaborative relationships within the community.Key ResponsibilitiesCommunity Engagement:Acquire and uphold a thorough...

Job SummaryVannguard Utility Partners is seeking a skilled Underground Utility Locator to join our team. As an Underground Utility Locator, you will be responsible for locating underground utilities using specialized equipment and computer utility maps.Key ResponsibilitiesDrive a company vehicle to job sites and utilize mapping tools to locate underground...

About UnitedHealth Group:UnitedHealth Group is a leader in the health care industry, dedicated to improving the health and well-being of individuals through innovative solutions and integrated care models. Our focus is on addressing the comprehensive needs of patients, including their physical, mental, and social health, ensuring they receive the support...

Position Overview:This is an introductory role within the Coding Division at the Central Billing Office. The individual will gain foundational knowledge of coding tools, including 3M 360. Responsibilities include reviewing clinical documentation and applying the correct billing and diagnostic codes in accordance with established guidelines. The goal is to...

Position Overview:This is an entry-level role within the Coding Department at BHMC-Little Rock, situated in the Central Billing Office. The position requires a foundational understanding of coding resources, including 3M 360. The individual will be responsible for reviewing clinical documentation and applying the appropriate billing and diagnostic codes in...

About UnitedHealth Group:UnitedHealth Group is at the forefront of transforming health care by integrating innovative solutions that address the comprehensive needs of individuals. Our mission is to enhance the health journey of patients by ensuring seamless transitions from hospital to home, particularly for older adults.Role Overview:The Inpatient Care...

Job SummaryThe University of Arkansas for Medical Sciences is seeking a highly skilled Medication Authorization Nurse to join our team. As a key member of our clinical review team, you will be responsible for ensuring the efficient and accurate review of medication authorization requests to ensure compliance with national standards.Key...

About the RoleWe are seeking a highly skilled Contract Setup Specialist to join our team at Future State Careers. As a key player in managing and reviewing contracts, you will ensure accuracy and compliance, and support project managers.Your responsibilities will include:Reviewing incoming contracts for completeness and identifying any risks.Utilizing...

Job Title: Travel Nurse RN SpecialistJob Summary:Arrow Healthcare Staffing is seeking a skilled travel nurse RN specialist to join our team in a CVICU setting. As a travel nurse, you will have the opportunity to work in a dynamic and challenging environment, providing high-quality patient care and collaborating with a multidisciplinary team.Job...