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The Utilization Review Specialist is an essential role at Mount Carmel Behavioral Health, an -bed inpatient acute treatment center for adult men and women who have been/currently are experiencing a wide range of mental or behavioral health challenges.
Part-timeExpandUpdated 18 days ago - UpvoteDownvoteShare Job
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Utilization management experience in a medical management review organization, such as Medicare Advantage and managed Medicaid. Evidence of analytic and interpretation skills, with prior experience participating in teams focusing on quality management, utilization management, and acute inpatient rehabilitation.
$274,400 a yearFull-timeExpandUpdated 18 days ago - UpvoteDownvoteShare Job
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May process complex lifetime medical and/or defined period medical claims which include state and physician filings and decisions on appropriate treatments recommended by utilization review.
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Medical Directors will participate in inter-rater review activities and other quality oversight processes for internal Director UM decisions. The Medical Director transacts Utilization Management (UM) activities (prior authorization and appeals) and responds to prescriber inquiries related to UM transactions and more generally related to CVS Health coverage policies.
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Provides timely expert medical review for requests to evaluate the medical necessity of services that do not meet utilization review criteria while located in a state or territory of the United States.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
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Description Summary:This position is responsible for pharmacist tasks, such as dispensing and compounding medication, counseling patients on medication and health subjects, interpreting prescriptions, managing patient drug therapy, and performing drug utilization.
Part-timeExpandApply NowActive JobUpdated Today - UpvoteDownvoteShare Job
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Perform Drug Utilization Review and Pre-verification workflow steps while supporting clinical initiatives (e.g.: MTM, adherence programs, and other initiatives to improve patient outcomes) in a centralized, closed-door pharmacy setting.
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The Quality Associate implements quality improvement initiatives within the Utilization Review department. Analyze review results to identify issues and gaps. Escalate high-risk factors for further review.
$53,600 a yearFull-timeRemoteExpandApply NowActive JobUpdated 18 days ago - UpvoteDownvoteShare Job
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The Utilization Review Specialist at Mount Carmel Behavioral Health, a joint partnership between Acadia Healthcare and Mount Carmel Health Systems, will serve as a partner to the UM department and other departments through the facility as a bridge between impacting direct patient care and financial stability of the facility.
Part-timeExpandUpdated 20 days ago - UpvoteDownvoteShare Job
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Working knowledge of laws, rules, and regulations regarding utilization review and discharge planning functions of government programs such Medicare, Medi-Cal, and CCS. Under the direction of both the Director and CDI Manager, the Clinical Documentation Specialist independently prioritizes and performs assigned duties and tasks.
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The Utilization Review Specialist is an essential role at Mount Carmel Behavioral Health, an 80-bed inpatient acute treatment center for adult men and women who have been/currently are experiencing a wide range of mental or behavioral health challenges.
Part-timeExpandUpdated 20 days ago - UpvoteDownvoteShare Job
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Participate in periodic review of policies and procedures and update as needed. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion and safety. Adhere to all company, local, state, and federal laws and guidelines, including HIPAA Fraud, Waste and Abuse, and DEA Procedures.
Full-timeExpandApply NowActive JobUpdated 1 month ago - UpvoteDownvoteShare Job
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As the Director of Case Management, you will use your clinical knowledge and contribute to the overall functions and professional growth of the department, including, but not limited to: Utilization Review (UR) and resource management, discharge planning, treatment plan management and financial management effectiveness.
Full-timeExpandUpdated 1 month ago - UpvoteDownvoteShare Job
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Proficient in Utilization Review processes, you'll maintain effective procedures to meet regulatory and reimbursement requirements for various payers, both commercial and government. As a Utilization Management Nurse/Social Worker, you'll play a crucial role in our multidisciplinary team, ensuring that patients progress seamlessly through their care journey according to appropriate admission statuses.
Full-timeRemoteExpandUpdated 1 month ago - UpvoteDownvoteShare Job
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Monogram’s innovative, in-home approach utilizes a national nephrology practice powered by a suite of technology-enabled clinical services, including case and disease management, utilization management and review, and medication therapy management services that improve health outcomes while lowering medical costs across the healthcare continuum.
Full-timeExpandUpdated 3 months ago
utilization review jobs in Columbus, OH
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