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CAREERBUILDER APPLY

Full Time

RN / Appeals Analyst Kelly Healthcare Resources (KHR) has an opportunity for an RN/Appeals Analyst to come and join our client located in Columbia, SC ! As the RN/Appeals Analyst with a large health insurance provider, you will research the substance of co...

Columbia, SC, USA

Full Time

MHM Services partnering with Centurion of TN to hire qualified healthcare professionals to work within the TN Department of Corrections in the provision of healthcare services to inmates throughout the state, we are seeking several UM Nurses....

Nashville, TN, USA

Full Time | Pay: $60,000 - $70,000/year

Our people are everything. As a Best of Staffing ® Client and Talent leader, Aerotek ® Inc. has distinguished itself as a leader in recruiting and staffing services, by having a deep understanding of the intersection of talent and business. As a strategic...

1206 Pointe Centre Dr #100, Chattanooga, TN, USA

Full Time

This position is responsible for analyzing clinical information submitted by medical providers to evaluate the necessity, appropriateness and efficiency of the use of medical services procedures and facilities. Is responsible for clinical review of all req...

919 Hidden Ridge, Irving, TX, USA

Contract to Hire

Our 657 bed hospital is both nationally and locally recognized, including being named as one of the nation's Top 100 Hospitals in the areas of cardiology, stroke, orthopedics and breast cancer management. As a result of the continued advances in quality ca...

Nashville, TN, USA

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CAREERBUILDER APPLY

Full Time

MAJOR JOB DUTIES AND RESPONSIBILITIES : Primary duties may include, but are not limited to: Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgi...

Indianapolis, IN, USA

CAREERBUILDER APPLY

Full Time | Pay: $73,000 - $85,000/year

The Home Health OASIS Coder facilitates the development and implementation of a patient-centered Plan of Care based on best practices, agency protocols, and an accurate comprehensive assessment. Schedule: Monday through Friday – Regular business hours Abil...

Broomall, PA, USA

Full Time

Responsible for the telephonic delivery, of the Utilization Management process to include: assessing, planning, implementing and, coordinating clinical recommendations regarding medical necessity for admission, continued stay and the development / implemen...

Louisville, KY, USA

Full Time | Pay: $93,000/year

Work Schedule: M-F, 8:00 a.m. - 5:00 p.m. Salary Range:$75k-93k Direct Hire/Permanent Location- New York, New York (Relocation Assistance Included) Benefits • 401k • Unlimited snacks and catered lunch 3x per week • Health and Wellness budget - $150 per qua...

Hoboken, NJ, USA

Full Time

The Utilization Management Nurse Consultant candidate will be able to utilize clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benef...

7400 W Campus Rd, New Albany, OH, USA

CAREERBUILDER APPLY

Full Time | Pay: $80,000 - $82,000/year

Exciting opportunity in Westchester, IL! Our client is a population Health Management organization that enables physicians to engage, support and manage new value-based savings and shared-risk models. We are currently recruiting for a Utilization Managemen...

Westchester, IL, USA

CAREERBUILDER APPLY

Full Time

Gathers and synthesizes clinical information in order to authorize services. Reviews health care services to determine consistency with contract requirements, coverage policies and evidence-based medical necessity criteria; collects and analyzes utilizatio...

Doral, FL, USA

CAREERBUILDER APPLY

Full Time | Pay: $70,000 - $90,000/year

Education/Experience: 3+ years of utilization management/quality improvement experience. Working knowledge and understanding of basic utilization management and quality improvement concepts. Previous experience as a lead in a functional area or managing cr...

Tigard, OR, USA

Full Time

• Evaluates clinical information using established national decision support criteria, Medical Mutual policies, individual patient considerations, and clinical judgment to determine appropriateness of services and procedures. Refers cases that are complex...

2060 E 9th St, Cleveland, OH, USA

Full Time

Med-Scribe, Inc. is searching for an excellent RN for a Utilization Management team that is devoted to serving the under-served. This non-profit managed care firm is accomplishing great things in our community! Be part of the change you want to see in the...

Rochester, NY, USA

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Full Time

Registered nurse that serves as a liaison between providers and external payers on issues related to intensity of service and severity of illness for client members. This position involves using clinical background in the coordination of services to improv...

Charleston, WV, USA

CAREERBUILDER APPLY

Full Time | Pay: $65,000 - $75,000/year

Education/Experience: 3+ years of utilization management/quality improvement experience. Working knowledge and understanding of basic utilization management and quality improvement concepts. Previous experience as a lead in a functional area or managing cr...

Tampa, FL, USA

CAREERBUILDER APPLY

Seasonal / Temp

We are actively seeking highly motivated Registered Nurses (RNs) with strong Utilization Review(UR) experience. The Utilization Review Registered Nurses (RNs) will perform comprehensive reviews to determine medical necessity including quality issues and ap...

Sacramento, CA, USA

Full Time

Fawcett Memorial Hospital is located in the Tampa Bay area along Florida's Gulf Coast. Celebrating over 40 years of providing quality healthcare to Charlotte County, our mission is to make each patient encounter an opportunity to heal, with care, and c...

Fawcett Memorial Hospital - Port Charlotte

Port Charlotte, FL, USA

CAREERBUILDER APPLY

Full Time | Pay: $35 - $37/hour

In conjunction with, and under the supervision of VP, Medical Management, Medical Director and Director, UM, evaluates and provides feedback as needed to treating physicians regarding a member's discharge and home care plans and available covered services...

19 S LaSalle St, Chicago, IL, USA

CAREERBUILDER APPLY

Full Time

Maybe you, or someone you know, is looking at nursing opportunities in managed care… take a look at these unique positions with our large managed care provider. Office based on Chestnut, Full and Part Time opportunities: 830am to 5pm or 930-130pm, with a g...

1 Metropolitan Square #2040, St. Louis, MO, USA

CAREERBUILDER APPLY

Full Time

Molina Healthcare Services (HCS) works with members, providers and multidisciplinary team members to assess, facilitate, plan and coordinate an integrated delivery of care across the continuum, including behavioral health and long term care, for members wi...

Troy Corporate Center II, 880 W Long Lake Rd, Troy, MI, USA

Full Time

The RN of Utilization Review works with physicians and other members of the multidisciplinary team to develop a plan for each patient from admission to discharge. The tasks and responsibilities include:...

Medical City - Dallas

Dallas, TX, USA

Contractor | Pay: $27.38/hour

Utilizes clinical experience and skills in a collaborative process to assess, plan, implement, coordinate, monitor and evaluate options to facilitate appropriate healthcare services/benefits for members in the prior authorization setting Gathers clinical i...

New York, NY, USA

Full Time

SPECIFIC ELEMENTS AND ESSENTIAL FUNCTIONS: This position will focus on initial and continued stay utilization review and denials to include assessment of medical records for appropriateness, level of care provided, including assessment of treatment modalit...

Richmond FSC

Richmond, VA, USA

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