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JOB SUMMARY The Utilization Review Registered Nurse (RN) provides a clinical review of cases using medical necessity criteria to determine the medical appropriateness of inpatient and outpatient servi

*Please note: We are hiring for four (4) roles: Three (3) full‑time hybrid positions One (1) hybrid role with weekend‑only hours Our Mission: Our mission is to drive financial wellness in healthcare

Job Details Job Location: Admin 3 - Idaho Falls, ID 83404 Position Type: Full Time Education Level: Accredited Nursing Program Job Category: Health CareMountain View Hospital is looking for a Utiliza

Copper Springs East Job Title: Utilization Review Specialist Job Type: Full-time Your experience matters At Copper Springs East, we are committed to empowering and supporting a diverse and determined

Now offering company-paid dental, vision, and life insurance We are actively seeking a detail-oriented and compassionate professional to work as a Utilization Review (UR) Specialist in our residential

Employment Type: Full timeShift: Description: Why MediGold? MediGold is a not-for-profit Medicare Advantage insurance plan serving seniors and other Medicare beneficiaries across the United State

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offeri

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offeri

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offeri

Role DescriptionMedical Review and Appeals – RNLead II - BPMWho We AreUST HealthProof is a trusted partner for health plans, offering an integrated ecosystem for health plan operations. Our BPaaS solu

Job Category:Executive Leadership Work Shift/Schedule:8 Hr Morning - Afternoon Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.About the Role:Job S

We are searching for a UM Denial Coordinator Licensed Vocational Nurse - someone who works well in a fast-paced setting. In this position, using a collaborative approach, the licensed vocational nurse

:The Lead UM Coordinator is a senior-level role responsible for providing advanced coordination, leadership, and expertise within GOBHI's Behavioral Health Utilization Management (UM) program supporti

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading hea

Major ResponsibilitiesManage incoming fax, phone, and portal communications or any other requests from internal and external customers pertaining to clinical requests, approvals, authorizations, and d

At CVS Health, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading hea

Anticipated End Date: Position Title: Utilization Management Rep I (US)Job Description: Utilization Management Representative I Virtual: This role enables associates to work virtually full-ti

The range for this role is $ $42.79/hour Actual base pay will be determined based on a successful candidate's work location, skills/abilities, experience, and education. Interested applicants must be

*About Us: *Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling ou

Medical Content and Review Specialist EVERSANA•London, England, UKTHE POSITION: The Medical Legal and Regulatory (MLR) review is an essential process in healthcare marketing to ensure advertising prom