Clinical Utilization Review Specialist

Job SummaryWe are seeking a highly skilled and experienced Clinical Utilization Review Specialist to join our team at Innovative Systems Group. As a key member of our team, you will be responsible for ensuring compliance with utilization management and quality review functions performed by medical groups and IPAs participating in our networks.Key...

Job SummaryWe are seeking a highly skilled Clinical Utilization Review Specialist to join our Medical Management/Health Services team at Centene Corporation. As a key member of our team, you will play a critical role in ensuring the quality and appropriateness of mental health and substance abuse services for our 28 million members.Key...

Job SummaryWe are seeking a highly skilled Clinical Review Specialist to join our team at Universal Health Services, Inc. As a key member of our Utilization Management team, you will be responsible for performing timely and accurate clinical reviews with all payer types to secure authorization for initial and continued treatment.ResponsibilitiesConduct daily...

Job SummaryWe are seeking a skilled Clinical Review Specialist to join our team at Universal Health Services. As a key member of our multidisciplinary treatment team, you will be responsible for performing timely, daily clinical reviews with all payer types to secure authorization for initial and continued treatment.ResponsibilitiesConduct thorough clinical...

Job Title: Drug Utilization Review SpecialistAt destinationone Consulting, we are seeking a highly skilled Drug Utilization Review Specialist to join our team. As a key member of our healthcare recruitment team, you will play a crucial role in evaluating medication use patterns to promote safe and effective medication therapy, ensuring optimal patient...

Job SummaryThis role is a key member of the Department of Care Coordination, supporting the Utilization Review (UR) team to enhance efficiency and timely responsiveness to payor requests. The primary responsibility is managing and triaging communication from insurance payors via email, fax, and phone inquiries pertaining to clinical requests, approvals,...

Job Summary:As a Utilization Specialist at Acadia Healthcare, you will play a critical role in ensuring the efficient and effective use of healthcare resources. You will serve as a liaison between managed care organizations and our facility's professional clinical staff, conducting reviews and coordinating communication regarding reimbursement requirements....

Job SummaryWe are seeking a highly skilled Utilization Management Specialist to join our team at HireOps Staffing LLC. As a key member of our team, you will be responsible for ensuring compliance with Utilization Management (UM) and Quality Review (QR) functions performed by Medical Groups/IPAs participating in our networks.Key ResponsibilitiesReview and...

Job SummaryWe are seeking a highly skilled Clinical Utilization Specialist to join our team at Acadia Healthcare. As a Clinical Utilization Specialist, you will play a critical role in ensuring the efficient and effective use of healthcare resources.Key ResponsibilitiesLiaison Role: Act as a liaison between managed care organizations and our facility's...

{"title": "Quality Utilization Specialist Emergency Department", "subtitle": "Join Our Team", "content": "About the RoleThe Quality Utilization Specialist, Emergency Department reflects the mission, vision, and values of Northwestern Memorial Healthcare, adheres to the organization\u2019s Code of Ethics and Corporate Compliance Program, and complies with all...

About the RoleWe are seeking a highly skilled Surgical Clinical Reviewer to join our team at Rush University. As a key member of our clinical quality improvement team, you will play a critical role in optimizing the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) and other clinical registries.Key...

Job SummaryWe are seeking a highly skilled Quality Utilization Specialist to join our team at Northwestern Memorial Healthcare. As a key member of our healthcare team, you will play a critical role in ensuring the highest quality patient care and optimal resource utilization in our Emergency Department.Key ResponsibilitiesApply medical necessity criteria,...

Job Title: Central Intake Clinical SpecialistJob Summary: We are seeking a highly skilled Clinical Intake Specialist to join our team at The Alden Network. As a key member of our Central Intake team, you will be responsible for clinically reviewing patient referrals, responding promptly to referral sources, and collaborating with facilities to ensure...

Job SummaryWe are seeking a highly skilled Medical Review Specialist to join our team at Mindlance. As a key member of our organization, you will play a critical role in evaluating medical benefit medication service requests made by our members and providers.Key ResponsibilitiesEvaluate medical benefit medication service requests using clinical judgment and...

Job SummaryWe are seeking a highly skilled Quality Utilization Specialist to join our team at Northwestern Memorial Healthcare. As a Quality Utilization Specialist, you will play a critical role in ensuring that our patients receive the highest level of care while also optimizing our hospital's resources.Key ResponsibilitiesApply medical necessity criteria...

Job SummaryThe Surgical Clinical Reviewer will oversee and optimize the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) and other clinical registries at Rush University System for Health.Key ResponsibilitiesOversee the correct identification and inclusion/exclusion of surgical patients based on NSQIP criteria and...

Job Title: Nurse Reviewer IJob Summary:The Nurse Reviewer I is a critical role in our organization, responsible for conducting preauthorization, out of network, and appropriateness of treatment reviews for diagnostic imaging services. This position requires a strong understanding of clinical and department guidelines, as well as excellent communication...

{"title": "Contract Review Specialist", "content": "Job SummaryAon is seeking a skilled Contract Review Specialist to join its contracts management team. The successful candidate will be responsible for reviewing, drafting, and negotiating complex contracts, including non-disclosure agreements, engagement letters, and master services agreements.Key...

Job SummaryThe Central Intake Clinical Specialist is a key role within The Alden Network, responsible for ensuring timely and accurate clinical reviews of patient referrals. This position requires strong communication and organizational skills, as well as the ability to work independently and as part of a team.Key ResponsibilitiesTimely review and respond to...

Job SummaryWe are seeking a highly skilled HEDIS Review Nurse to join our team at Integrated Resources. As a key member of our team, you will be responsible for medical record abstractions and overreads during the annual Healthcare Effectiveness Data and Information Set (HEDIS) survey.Key ResponsibilitiesAbstract medical records in accordance with NCQA...