- UpvoteDownvoteShare Job
- Suggest Revision
The Utilization Review Specialist will also perform pre-certification reviews, concurrent reviews and will perform appeal reviews as needed. Three to Five (5) years experience in Case Management/Utilization Review (as either CADC, LAADC, LCSW, LMHC, LMFT, or Utilization Review Coordinator.
$48,000 - $52,000 a yearRemoteExpandApply NowActive JobUpdated 7 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Performs prior authorization, precertification, and retrospective reviews and prepares decision letters as needed in support of the utilization review contract Assists management with training new Nurse Reviewers to include daily monitoring, mentoring, feedback and education.
RemoteExpandUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Understanding of ICD10 Coding in relation to DRGsAbstract additional data elements during the chart review process when coding as neededUtilize technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10- CM diagnoses and ICD- IO-PCS procedures.
$44.13 - $52.7 an hourFull-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Advise and assist contracts team members, researchers and administrative staff on the contracting processes including providing guidance on federal regulations, agency requirements, and internal policies and procedures; review of contracts with a wide range of federal, state, local government agencies, and private foundation sponsors to ensure conformance to funding agency and University requirements.
RemoteExpandUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Active and unrestricted RN license required 5+ years clinical experience in an inpatient hospital setting required 2+ years utilization review experience or claims auditing required Experience using Milliman or InterQual criteria required What you should expect in this role Home-based position only for residents of Wyoming.
$49,200 - $70,300 a yearRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
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.
RemoteExpandUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
Actively participates in prior authorizations and utilization review for TMS, Spravato, and medicationsAssists with accreditation and credentialing efforts as needed. Provides training and support to clinical care coordinator as needed.
Full-timeRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Supports clinical trial readiness by working with clinical operations and CROs as needed for generation/review/editing of clinical study documentation including IRB/IBC communications/responses, study manuals, etc.
RemoteExpandApply NowActive JobUpdated 10 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Enter, review and or verify member information in the nH Coordinate care management platform and communicate approved pertinent information with healthcare providers and/or naviHealth team as needed.
Full-timeRemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Associate Medical Director will, as permitted by applicable law and consistent with Associate Medical Director's clinical judgment, order any necessary scheduled narcotic or other scheduled medications needed for WellBe patients in collaboration with the WellBe Senior Medical Advanced Practice Clinicians during the time said Advanced Practice Clinicians are awaiting appropriate credentials from the U.S. Governmental Drug Enforcement Agency.
RemoteExpandApply NowActive JobUpdated 5 days ago - UpvoteDownvoteShare Job
- Suggest Revision
3-5 years clinical nursing experience, with 1-3 years Managed Care Experience in the specific programs supported by the plan such as Utilization Review, Medical Claims Review, Long Term Service and Support, or other specific program experience as needed or equivalent experience (such as specialties in: surgical, Ob/Gyn, home health, pharmacy, etc.
RemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Abstract additional data elements during the chart review process when coding, as needed. Provide documentation feedback to providers, as needed, and query physicians when appropriate.
Full-timeRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
Participates in weekly team meetings and communicates patient treatment goals with all team members as needed. For a virtual tour of the facility, please visit our website at aneweratms.com Qualifications Master’s or Doctorate degree in relevant field, required Completion of state requirements to conduct therapeutic interventions, (ACSW, AMFT, APCC, etc) required Obtain BLS, CPR, AED, and First Aid certification within 90 days of hire Must possess a current driver’s license and be in good standing Not sure if you meet all the qualifications.
$60,000 a yearFull-timeRemoteExpandUpdated Today - UpvoteDownvoteShare Job
- Suggest Revision
MNS is hiring a Senior Project Engineer to coordinate, oversee, review and take responsible charge on the delivery of projects related to the planning and design of water/wastewater systems (pipelines, pump stations, treatment systems, and similar), as well as the study of floodplain and stormwater to the design of drainage systems, and similar.
$104,000 - $148,000 a yearRemoteExpandApply NowActive JobUpdated 4 days ago - UpvoteDownvoteShare Job
- Suggest Revision
We are seeking a talented individual for a Nurse Reviewer who will be responsible for performing clinical reviews to determine if the medical record documentation supports the need for the service based on clinical criteria, coverage policies, and utilization and practice guidelines as defined by review methodologies specific to the contract for which services are being provided.
RemoteExpandApply NowActive JobUpdated 4 days ago
Remote needed review jobs
FEATURED BLOG POSTS
How to Build a Candidate Persona
A candidate persona is a semi-fictional representation of your ideal candidate. Building a candidate persona is one of the best methods employers use to ensure their sourcing, recruiting, and hiring processes are focused. Knowing exactly what you're looking for streamlines everything and helps increase hiring confidence. So here's how to create a candidate persona and how to use it.
How to Get Into The Trades: Step-by-Step Guide
Getting a trade job can be a great career move if you like variety and prefer to learn on the job instead of in an academic setting. A trade job can offer security and be a lucrative career path as the demand for skilled trade workers continues to grow.
How do Good Interviewers Prepare for Interviews?
Just like candidates take the time to research you and your company, you should take the time to prepare for the interview. Preparing for the interview doesn't just reflect well on your employer brand and create a better candidate experience. Preparation also helps prevent bad hiring decisions. Bad hiring decisions are usually a result of poor execution during the hiring process. However, going into an interview fully prepared and ready to evaluate candidates will help avoid bad hires. So, here are 6 interview preparation tips for employers.
How to Get a Union Job? A Step-by-Step Guide
A union job can significantly impact your job security, pay, and employment benefits. Whether this is your first job or you have years of experience, a union job can offer much-needed protection in a labor market where employees are hired and fired at will.
Should I Hire for Potential Over Experience?
The workforce is shifting every day. In fact, research from the World Economic Forum (WEF) shows over half of employees around the world will need to upskill or reskill by 2025. The rapid rise of digital literacy, automation, and new technologies will quickly supersede businesses that don't train ahead of the curve. With the dire need to invest in training, it's evident that hiring someone with experience isn't that much different than hiring someone without it.
How to Decide Between Two Job Offers: 10 Practical Tips
It’s arguably a good predicament to have. You’ve applied to many jobs, interviewed multiple times, and now find yourself with two legit job offers. Nice! But although this is a feel-good validation of everything you have to offer, a daunting choice lies ahead. How do you decide which job will be the best fit for you?
Why Work in Sales? 9 Reasons & Tips on Answering as an Interview Question!
Working in sales can be demanding and challenging, but it can also be gratifying. Sales is an excellent career with a clear path full of excitement and potential for growth. So, if you're contemplating careers and have wondered "why work in sales?", keep reading to determine if sales is a suitable role for you.