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The Utilization Management Nurse Reviewer plays a crucial role in healthcare systems by ensuring that medical services are used efficiently and appropriately. Utilization Management Nurse Reviewers collaborate with healthcare providers, insurance companies, and patients to optimize healthcare delivery, control costs, and maintain quality care.
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Minimum of six (6) years in a managed care operations, working with one or more of the following areas: Utilization Management, Claims, Pharmacy Operations, Compliance, FDR oversight activities, Quality Management, Care Management, and/or Grievances and Appeals.
$38.37 - $48.93 an hourFull-timeExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
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One year of previous experience in Utilization Management is preferred. Keep up-to-date with regulatory prerequisites (such as URAC) and state standards for utilization review. We provide customized Independent Medical Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
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Foster efficient and high-quality patient care by effectively communicating with management teams, physicians, and the Medical Director. Input and manage essential clinical details within various medical management platforms.
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The Stock Clerk performs warehouse functions which include but, not limited to (i.e., receives, stores, and issues equipment, materials, supplies, and compiles stock records of items within the warehouse and/or storage yard, inventory management, storage management, cataloging, property utilization etc.
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Their responsibilities include assessing medical necessity, coordinating care, conducting utilization reviews, providing recommendations for care plans, and ensuring adherence to regulations and guidelines.
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Interns with the Training and Development team will have the opportunity to engage with all components of Cedar Point Academy and associated HR training programs including Orientation/Onboarding, Learning Management System tracking, training compliance, Leadership Development, Talent Management, and OJT support.
InternExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintains PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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Preferred: Experience in Utilization Management/Case Management, Critical Care, patient outcomes/quality management and/or inpatient coding, ICU/Critical Care, clinical documentation improvement, ICD coding and MS-DRGs, working in a clinical documentation improvement department or as a consultant and minimum of one (1) year auditing experience.
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Background in and understanding of energy project processes, such as: biofuels processing; gas stream and solvent systems; carbon capture, utilization, and storage (CCUS) technologies; hydrogen generation (e.g., electrolysis, natural gas reformation) storage, and transportation systems; amine solvent processes for CO2 removal; etc.
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Management Solutions is a national award-winning management consulting firm that specializes in clean energy program management, organizational maturity assessment, environmental services, and project strategy and implementation.
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Dartmouth-Hitchcock Keene is seeking a Physician Advisor (PA) with expertise in Utilization Management, Care Management, and Clinical Documentation. The PA supports Utilization Management by performing concurrent, evidence-based second-level medical necessity reviews, educating physicians on medical necessity for inpatient/outpatient services, reviewing Medicare Condition Code 44 downgrades, Medicare Outliers for medical necessity, metrics on length of stay and readmission, and taking action where appropriate.
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Management Solutions LLC is an Equal Employment Opportunity (EEO) employer. This position will work closely with the Office of Clean Energy Demonstrations (OCED) which is a multi-technology office responsible for overseeing more than $27B of investment in large scale demonstrations in emerging technologies such as clean hydrogen, carbon capture, advanced nuclear reactors, grid-scale energy storage, industrial emissions reductions as well as demonstrations in rural and socioeconomically disadvantaged regions.
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Founded in 2002, MSLLC has been named Small Business of the Year by the U.S. Small Business Administration, the Department of Energy, and the Oak Ridge National Laboratory. Conduct independent engineering / due diligence technical advisory reviews of clean energy technologies, processes, and projects.
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Participates in Pharmacy, Therapeutic, and Strategic Initiatives, Patient Safety/Sentinel Event Committee, Performance Improvement, Electronic Medical Records (EMR), Utilization Management and other process improvement committees/initiatives as directed or assigned.
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