Clinical Utilization Review Specialist

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 members.Job Summary:We are seeking a highly skilled Clinical Utilization Review Specialist to join our...

Job SummaryWe are seeking a highly skilled Licensed Utilization Review II to join our team at Elevance Health. As a key member of our healthcare team, you will play a critical role in ensuring the appropriate and consistent administration of plan benefits.Key ResponsibilitiesWork with healthcare providers to collect clinical information required for...

Job SummaryWe are seeking a highly skilled Clinical Pharmacist to join our team in Kansas. As a Clinical Pharmacist, you will play a critical role in managing the selection and utilization of pharmaceuticals, supporting core clinical programs, and providing clinical expertise to our team.Key ResponsibilitiesResearch and synthesize detailed clinical data...

CoreCare Utilization Management SpecialistVitalCore Health Strategies is seeking a highly skilled CoreCare Utilization Management Specialist to join our team. As a key member of our Utilization Management team, you will be responsible for reviewing and analyzing medical data to ensure accurate and timely authorization of patient services.Key...

Job SummaryCVS Health is seeking a skilled Clinical Utilization Management Specialist to join our team. As a Utilization Management Nurse Consultant, you will play a critical role in coordinating, documenting, and communicating all aspects of the utilization/benefit management program.Key Responsibilities Utilize clinical experience and skills to assess,...

Job SummaryCVS Health is seeking a skilled Utilization Management Nurse Consultant to join our team. As a key member of our healthcare services team, you will play a critical role in coordinating and managing the utilization of healthcare services for our members.Key ResponsibilitiesUtilize clinical expertise to assess, plan, implement, coordinate, monitor,...

Job SummaryWe are seeking a highly skilled Utilization Management Representative to join our team at Elevance Health. As a key member of our healthcare team, you will play a critical role in ensuring that our members receive the best possible care while also managing costs and improving outcomes.Key ResponsibilitiesCoordinate cases for precertification and...

Job Title: Clinical Psychologist ReviewerWe are seeking a highly skilled Clinical Psychologist Reviewer to join our team at Elevance Health. As a Clinical Psychologist Reviewer, you will play a critical role in ensuring the quality and appropriateness of behavioral health services provided to our members.Key Responsibilities:Collaborate with providers and...

Job SummaryWe are seeking a highly skilled Medical Management Specialist to join our team at Elevance Health. As a Medical Management Specialist, you will play a critical role in providing non-clinical support to our Medical Management and Operations areas.Key ResponsibilitiesGather and analyze clinical information to determine the best course of action for...

About the RoleEvolent Health is seeking a highly skilled Correspondence Policy Specialist to join our Shared Services team. As a key member of our team, you will play a critical role in ensuring compliance with legislative and accreditation requirements, while maintaining high-quality clinical correspondence.Key ResponsibilitiesDevelop and customize...

Job Summary:As a Clinical Pharmacist PRN Specialist at AdventHealth, you will play a vital role in ensuring the safe and effective use of medications for our patients. This is a PRN (as-needed) position, requiring flexibility to work various shifts, including weekdays and weekends. You will be part of a dedicated team that prioritizes whole-person care,...

Job SummaryWe are seeking a highly skilled and experienced Clinical Leadership Specialist to lead our APA-accredited training program and provide administrative and clinical leadership to our team.Key ResponsibilitiesProvide administrative and clinical leadership for the training program, including coordination with educational institutions and maintenance...

Job SummaryWe are seeking a highly skilled and experienced Clinical Leadership Specialist to join our team at FCS, Inc. As a key member of our leadership team, you will be responsible for providing administrative and clinical leadership for our APA accredited training program.Key ResponsibilitiesProvide administrative and clinical leadership for the APA...

OverviewWe are seeking a highly skilled Clinical Informatics Specialist to join our team at The University of Kansas Health System St. Francis Campus. As a key member of our healthcare team, you will be responsible for providing exceptional support and expertise in the implementation and optimization of our electronic medical record (EMR)...

Job SummaryCVS Health is seeking a skilled Clinical Case Manager to join our team. As a Clinical Case Manager, you will play a critical role in facilitating appropriate member physical health and behavioral healthcare through assessment and care planning, direct provider coordination/collaboration, and coordination of psychosocial wraparound services.Key...

Job SummaryCVS Health is seeking a skilled Clinical Nurse Consultant to join our team. As a key member of our Utilization Management department, you will play a critical role in assessing, planning, implementing, coordinating, monitoring, and evaluating options to facilitate appropriate healthcare services and benefits for our members.Key...

Job Title: Program SpecialistCommunity Care Network of Kansas is seeking a highly skilled Program Specialist to join our team. As a key member of our staff, you will be responsible for directing and supporting our program data systems, ensuring accuracy and completeness of data collected, and providing programmatic support to ensure work plan activities are...

Job SummaryWe are seeking a highly skilled Speech Language Pathology Therapist Reviewer, Sr. to join our team at Elevance Health. As a key member of our organization, you will be responsible for reviewing medical records to determine the medical necessity of therapy services.Key ResponsibilitiesApply professional knowledge of therapy, government regulations,...

Job SummaryWe are seeking a highly skilled and experienced Clinical Leadership Specialist to join our team at Fcs Co.The ideal candidate will possess a strong background in psychology and training management, with excellent leadership and communication skills.Key ResponsibilitiesProvide administrative and clinical leadership for our APA-accredited training...

Job Summary:The Medical Management Specialist I is a key role within our organization, responsible for providing non-clinical support to the Medical Management and/or Operations areas. This position requires a strong understanding of managed care and Medicaid/Medicare, as well as excellent communication and organizational skills.Key Responsibilities:Gather...