SUMMARY:The Utilization Review Specialist will perform utilization review of pre-certification and concurrent clinical utilization reviews with insurance companies in accordance with certification requirements of each patient's insurance plan.

Salary is commensurate with experiencePicture Yourself At Gaudenzia as a Utilization Review Specialist at our Pregnant & Parenting Women's Programs! Acceptable certification and licensures include, but are not limited to: CAC, CADC, LCADC, LSW, LICSW, LGSW, etc.

Promote quality and cost effectiveness of healthcare by the appropriate application of policies and guidelines to prior authorization and concurrent review requests. Ensure all members are receiving the right care, in the right place, at the right time through Utilization Review and Discharge Planning work.

The utilization review nurse will work on defined patient populations and is responsible for an initial clinical review at the point of patient entry to the inpatient care setting, this includes observation status.

Behavioral Health Care Coordinators (UMC) are licensed healthcare professionals (Registered Nurses/RNs and Licensed Social Workers/LSWs) that provide our members with post-discharge behavioral health/substance abuse care coordination to ensure a safe and effective transition to the next level of care.

The Contractor shall frequently collaborate with managers of the UBO, Utilization Review Registered Nurse (RN) and pre-certification clerk. The Contractor performing as the License Practical Nurse (LPN) Utilization Reviewer (UR) shall make coverage decisions based on DoD regulations, and reference use of Milliman Care criteria and InterQual guidelines.

Back RN - UTILIZATION MANAGEMENT - CARE COORDINATION - REMOTE OPTION Category: Nursing Location: Wausau, WI Job Schedule: PARTTIME Job Number: 8870 Apply To Job Aspirus was recently recognized as one of the 15 Top Health Systems in the United States by IBM Watson in their annual study identifying the top-performing health systems in the country based on overall organizational performance.

Review or prepare withdrawals for consumption with designated Customs Broker. Review or prepare FTZ admissions (e-214). Review or prepare withdrawals for exportation and IT (QP/WP CBP Forms 7512.

This role will oversee projects and be responsible for continuous communication with the client and team members, along with executing project lifecycle tasks for transaction monitoring engagements.

Attend segment/business credit risk management committee meetings aligned with area of subject matter expertise; act as a risk management resource to the business units; communicate key takeaways to broader Credit Review team.

Job DescriptionMedical Claim Review Nurse (LVN)LVN Medical Claim Reviews (OH Medicaid & Market Place) For this position we are seeking a (LVN) Registered Nurse with previous experience in Concurrent Review/ Utilization Review / Utilization Management and knowledge of Interqual / MCG guidelines and/or strong hospital clinical skills.

This role will oversee projects and be responsible for continuous communication with the client and team members, along with executing project lifecycle tasks for transaction monitoring engagements.

Responsibilities of Utilization Review Specialist: Collaborate as the patient advocate with the clinical team and operational leadership regarding overall case and treatment processes to aide in improved Utilization Review outcome.

Under the direction of the Director of Admissions & Utilization Review, the Utilization Review Specialist will coordinate Medicaid Managed Care benefits and approvals for clients receiving behavioral healthcare services from Odyssey House's Part 820 residential programs.

Overview Summary: The EHS Specialist, under the supervision of the Senior EHS Manager, will be responsible for development and application of various safety and compliance programs at Fujifilm Diosynth Biotechnologies Texas (FDBT.