Utilization Reviewer

Required Qualifications:• Bachelor’s degree in nursing (BSN)• Active unrestricted RN license that can be validated thru PRC website• 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department• Written and verbal fluency in English•...

Required Qualifications: • Bachelor’s degree in nursing (BSN) • Active unrestricted RN license that can be validated thru PRC website • 1-2 years of relevant Clinical experience in any medical/surgical department, Orthopedic, Medical/Surgical ICU, Coronary Care Unit (CCU), Rehabilitation, Emergency department • Written and verbal fluency in...

Roles and Responsibilities: • PH Nurses to review treatment authorization request based on state guidelines and medical necessity and take decision to approve/deny. In case of denial send this to independent panel review to support the decision. Nurses will work with Claims adjuster on denial decision based on risk tolerance to ensure the denial doesn’t...

Roles and Responsibilities: • PH Nurses to review treatment authorization request based on state guidelines and medical necessity and take decision to approve/deny. In case of denial send this to independent panel review to support the decision. Nurses will work with Claims adjuster on denial decision based on risk tolerance to ensure the denial doesn’t...

Summary: The Clinical Review Nurse position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the Client Claims Adjuster team to expedite medically necessary treatment for each claim. Maintains a solid understanding of Client’s mission, vision, and values. Upholds the standards of the...

Summary: The Clinical Review Nurse position assesses the medical appropriateness of proposed treatments and medications for our injured employees, and partners with the Client Claims Adjuster team to expedite medically necessary treatment for each claim. Maintains a solid understanding of Client’s mission, vision, and values. Upholds the standards of the...

Responsibilities: Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards Conduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments,...

Responsibilities: Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance Standards Conduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments,...

Responsibilities:Carry out quality assurance oversight activities defined in the Client Managed Care National Best Practices and Quality Assurance StandardsConduct regular and systematic review of Managed Care internal and external claim files with focus towards validation of consistent evaluation of evidence-based medicine, comprehensive assessments,...

Responsibilities: Research, plan, develop, implement and evaluate training strategies, initiatives, and materials including comprehensive education programs to meet orientation and ongoing competency needs and professional development needs Assess data and information related to claim medical outcome and other pertinent situations including identification of...

Responsibilities: Research, plan, develop, implement and evaluate training strategies, initiatives, and materials including comprehensive education programs to meet orientation and ongoing competency needs and professional development needs Assess data and information related to claim medical outcome and other pertinent situations including identification of...

Responsibilities:Research, plan, develop, implement and evaluate training strategies, initiatives, and materials including comprehensive education programs to meet orientation and ongoing competency needs and professional development needsAssess data and information related to claim medical outcome and other pertinent situations including identification of...

Educational Background: B.S NursingQualifications: 8+ years of related experience or equivalent combination of education and experiencerequired to include 2+ years of direct clinical care OR 2+ years of casemanagement/utilization management required.  Bachelor's degree in nursing (BSN) from accredited college or university or equivalentwork experience...

Educational Background: B.S Nursing Qualifications:  8+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required.  Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work...

Job Description Responsibilities: Develops innovative approaches. Serves as a leader/ mentor. Comply with the terms and conditions of the employment contract, company policies and procedures. Sought out as expert. Reviews the work of others. Required Skills: BS Nursing – USRN Active Mainland License. Hospital Experience in Critical Areas (ER, Med...

Job Description Responsibilities: Develops innovative approaches. Serves as a leader/ mentor. Comply with the terms and conditions of the employment contract, company policies and procedures. Sought out as expert. Reviews the work of others. Required Skills: BS Nursing – USRN Active Mainland License. Hospital Experience in Critical Areas (ER, Med...

Educational Background: B.S Nursing Qualifications:  8+ years of related experience or equivalent combination of education and experience required to include 2+ years of direct clinical care OR 2+ years of case management/utilization management required.  Bachelor's degree in nursing (BSN) from accredited college or university or equivalent work...

Responsible for interviewing patients, retrieve and review information to compose accurate and complete medical records. College Degree – BS Nursing or other Medical allied course. Communication and listening skills Excellent command of written English Writing Skills Knowledge in History Taking Responsible for the delivery of services or projects as...

Full job description Responsibilities: Review, validate and ensure timely delivery and accuracy of reports prepared by Intraday Analysts as well as from other WFM disciplines (Forecasting, Capacity Planning, Scheduling and Reporting). Responsible for developing and ensuring integrity and consistency of set WFM processes/procedures applicable to the...

Responsibilities: Review, validate and ensure timely delivery and accuracy of reports prepared by Intraday Analysts as well as from other WFM disciplines (Forecasting, Capacity Planning, Scheduling and Reporting). Responsible for developing and ensuring integrity and consistency of set WFM processes/procedures applicable to the accounts being handled....