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Epic certification in one of the following Tapestry modules: AP Claims and Contracts, Enrollment and Eligibility, Referrals and Authorization, Utilization Management. Implement and configure Epic Tapestry modules such as AP Claims and Contracts, Enrollment and Eligibility, Referrals and Authorization, and Utilization Management.
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Serves as a liaison with headquarters, TRICARE regional offices, MTF staff and professional organizations concerning Utilization Management practices. Completes all required electronic medical record training, MTF-specific orientation and training programs, and any AF/DoD mandated Utilization Management training.
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Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program. Consults and lends expertise to other internal and external constituents in the coordination and administration of the utilization/benefit management function.
Full-timeExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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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 Today - UpvoteDownvoteShare Job
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By continuously reviewing and auditing participant treatment files, the Utilization Management Nurse will ensure that participants receive necessary procedures, effective treatment through collaboration with external hospital and skilled nursing facilities teams reducing the opportunity for readmission.
$79,040 a yearFull-timeExpandApply NowActive JobUpdated 6 days ago - UpvoteDownvoteShare Job
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Utilization management, quality management, network management and claims. The organization is nationally recognized for excellence in patient care and patient experience, and the College of Healthcare Information Management Executives (CHIME) has identified PIH Health as one of the nation’s top hospital systems for best practices, cutting-edge advancements, quality of care and healthcare technology.
$144,206.41 - $237,931.2 a yearFull-timeExpandApply NowActive JobUpdated Yesterday - UpvoteDownvoteShare Job
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The Telephone Triage Nurse is responsible for providing safe and effective telephone assessments, patient care instructions, direction to the appropriate level of care, and providing utilization management review of worker's compensation claims.
Full-timeRemoteExpandApply NowActive JobUpdated 11 days ago - UpvoteDownvoteShare Job
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Piper Companies is currently seeking a Remote Utilization Management Nurse for a remote opportunity within a health insurance organization. Responsibilities of the Remote Utilization Management Nurse:Responsible for performing medical reviews to assess, and coordinate quality care for patientsDetermine medical necessity utilizing MCG criteria and medical policy/contractual benefits.
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Qualified candidates will have prior LTSS or Medicare Inpatient Utilization Management experience within a Managed Care setting, LTSS, MLTC MAP, will have a NYS Registered Nurse License , familiar with MCG/Milliman/Interqual Guidlines and a desire to join a great team.
$102,000 - $107,000 a yearFull-timeRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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RN Coordinator - Utilization Management & Discharge PlanningSummaCare - 1200 E Market Ave, Akron, OHPart-Time / 20 Hours / Days (2 days one wk / 3 days next wk)RemoteSummary:While taking direction from the Manager of UM, the UM Coordinator helps daily to prioritize, coordinate, and implement utilization, discharge planning, regulatory and compliance activities with the UM team.
$33.66ExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Areas of responsibility include Bankruptcy, Foreclosure, Loss Mitigation, REO and Property Preservation, Claims or Default Administration. Progressive experience and significant exposure to all default areas of loan servicing including Collections, Loss Mitigation, Foreclosure, Bankruptcy, REO, Claims and Default Compliance.
Full-timeExpandApply NowActive JobUpdated 8 days ago - UpvoteDownvoteShare Job
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Acentra is currently looking for a Utilization Management Appeals Nurse – LPN/RN to join our growing team. Our Utilization Management Appeals Nurse – LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations.
$24 - $35 an hourFull-timeExpandApply NowActive JobUpdated 3 months ago - UpvoteDownvoteShare Job
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For nearly two decades, Wexford Health has consistently delivered proven staffing expertise and a full range of medical, behavioral health, pharmacy, utilization management, provider contracting, claims processing, and quality management services.
Full-timeExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Reviews and analyzes contract management records to provide advice for the purposes of limiting exposure or protecting the Company from additional risks due to changes and claims. Working closely with the Project Controls Manager, ensures accurate training and utilization of approved systems for project document control and reporting.
$180,000 - $225,000 a yearFull-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator). The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated 7 days ago
claims utilization management jobs Company: Metroplus Health Plan
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