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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.
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Job Overview: The Utilization Review Specialist is responsible for all aspects of the authorization of treatment via insurance and managed care companies. The Utilization Review Specialist provides appropriate client information to third party payers regarding the medical necessity of treatment in a timely manner.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Utilization Review Specialist/Behavioral Health Substance Abuse. Prior Utilization Review experience in a Substance abuse environment is mandatory. Performs other duties as assigned by the Director of Utilization Review.
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As the Credentialing Specialist, you MUST have at least Two (2) years’ experience with Provider credentialing protocols, resources, process and regulatory requirements as well as two (2) years administrative experience supporting mid to high level management in a corporate environment and be able to utilize Microsoft Office Suite including: Word, Excel, PowerPoint, and Adobe Acrobat.
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Landfill gas and LFG utilization (or other biogas management) Work with multidisciplinary teams to undertake solid waste management and other infrastructure projects related to planning, design, and construction.
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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.
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Oversee all MCO functional areas, including quality management, utilization management, network development and management, provider relations, member outreach and education, member services, contract compliance, and reporting.
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Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, case management, discharge planning and/or home health or post-acute services (such as inpatient rehabilitation.
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He/she serves as Credentialing Manager for Esperanza, coordinates provider on and off-boarding and manages the department budget. Prepare and submit credentialing applications for new clinicians with Medicaid and Medicare.
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Incumbent will work with the PMO Director to plan and manage utilization, including responsibility for hiring and management of consulting resources as needed. The PMO Manager will lead day to day operations for the UC Health IT Project Management Office's applications portfolio, including accountability for the delivery of projects and programs to set scope, time and budget targets.
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Data Management: Oversee the collection, processing, and utilization of data for training the chatbot, ensuring sensitivity and compliance with data protection regulations. Minimum of 5 years of experience in cloud infrastructure design and management, with a strong focus on Microsoft Azure.
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Our projects range from waste management planning and permitting to design, engineering and construction of waste management facilities (landfills, recycling facilities, transfer stations) and resource recovery endeavors (organic waste management, material recovery facilities, digestion, compost, and waste to energy operations.
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Responsible for gaining knowledge with a high proficiency in the areas of patient accounting, general ledger accounting/AP/payroll, third-party reimbursement, resource management, HIM, materials management, information systems, and internal audit control structure (to include assisting the Internal Audit Team with on-site audits in other markets.
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Job DescriptionAcentra is currently looking for a Utilization Management Appeals Nurse - LPN/RN to join our growing team. Job Summary:Our Utilization Management Appeals Nurse - LPN/RN will help orchestrate the seamless resolution of appeals in line with health regulations.
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Is prepared to conduct PPS meetings maintaining MDS assessments per Medicare schedule and maintain PPS board for monitoring of Medicare days and RUGs utilization in the absence of the Care Management Coordinator.
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utilization management credentialing jobs Company: Metroplus Health Plan
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