MDS Utilization Review Healthcare Specialist

ISTA Solutions is currently looking for experienced PHRN who have previous experience dealing with US Healthcare Insurance accounts, particularly in Utilization Management. This position entails semi-back-office work dealing with US-based Clients related to Claims, Benefits, Eligibility, Appeals, Prior Authorization, and particularly in MDS Utilization...

ISTA Solutions is currently seeking an experienced PHRN to fill a key position in our team. The ideal candidate will have a strong understanding of US Healthcare Insurance accounts and be able to conduct reviews in accordance with US State/Federal and other mandated regulations.Job Description:Performs UM reviews for inpatient services according to the...

**Role Overview:**This Clinical Support Representative role at Genfinity Philippines, Inc. involves providing critical support to utilization management teams.You'll be responsible for processing incoming requests, verifying treatments, and maintaining accurate demographic information.**Key Responsibilities:**Process requests accurately and...

About the RoleWe are looking for an experienced PHRN to join our team at ISTA Solutions, specializing in Utilization Management. The ideal candidate will have a strong understanding of US Healthcare Insurance accounts and be able to conduct reviews in accordance with US State/Federal and other mandated regulations.Responsibilities:Perform UM reviews for...

About the RoleThe Registered Nurse - Care Coordination position plays a critical role in ensuring patients receive the necessary care and support throughout their treatment journey.You will perform initial and concurrent reviews of inpatient cases, applying MCG criteria or InterQual Criteria for approval. Your expertise will be utilized to discuss cases with...

Job DescriptionA Healthcare Data Specialist role involves reviewing and analyzing patient medical records to ensure data accuracy and compliance with healthcare standards. Responsibilities include managing documentation, performing utilization reviews, and providing case management support through non-voice channels.Key Responsibilities:Manage patient...

Job Description:We are seeking a skilled Medical Case Manager to join our team at Genfinity Philippines, Inc. as a Utilization Review Specialist.Company Overview:Our company is a premier multiline claims services provider dedicated to promoting quality medical care in a prompt and cost-effective manner.About the Role:This role will involve facilitating...

Job OverviewAs a Corporate Utilization Strategist at MAESTRO HOLDINGS, you will play a crucial role in the supervision of the Corporate Utilization Strategy Department. This team focuses on developing strategies to optimize corporate utilization, ensuring that our members receive cost-effective and high-quality healthcare services.Key...

Are you passionate about regulatory affairs and looking for a challenging role in a dynamic company?Look no further! We are Allegens Healthcare, a leading healthcare company dedicated to delivering innovative solutions for a healthier world.About the RoleThe Regulatory Affairs Executive will be responsible for managing the registration process of our...

About the RoleWe are seeking a Strategic Healthcare Manager to join our Corporate Utilization Strategy Department at MAESTRO HOLDINGS. As a key member of this team, you will be responsible for developing and implementing strategies to optimize corporate utilization, ensuring that our members receive high-quality and cost-effective healthcare services.Key...

Job SummaryThe Utilization Management Director will lead the Corporate Utilization Strategy Department at MAESTRO HOLDINGS, focusing on developing and implementing strategies to optimize corporate utilization. The ideal candidate will have a strong background in healthcare management, excellent leadership skills, and the ability to analyze complex data to...

About This RoleThis position requires a strong understanding of authorization processes and excellent communication skills. The ideal candidate will be able to work independently and as part of a team to achieve common goals.Key ResponsibilitiesReview and process authorization requests from insurance companies.Handle inbound and outbound calls professionally...

US Healthcare Staffing Specialist OpportunitySysgen is looking for an experienced US Healthcare Staffing Specialist to lead our recruitment efforts in the US market.The successful candidate will be responsible for developing and executing targeted recruitment strategies to meet client needs.Key AccountabilitiesDevelop and maintain strong relationships with...

We are looking for a Healthcare Liaison Specialist to join our team at Halcyon Health Network, Inc. This role involves facilitating urgent patient care by reviewing referrals and tracking their progress. The successful candidate will ensure timely updates on PEME status by communicating with relevant medical units.ResponsibilitiesReview referrals and track...

About the RoleInlife Health Care is seeking a skilled Healthcare Services Coordinator to join our team. This role plays a crucial part in ensuring that IHC members receive effective and efficient administrative support. As a Healthcare Services Coordinator, you will be responsible for providing assistance to insured members during their availments and...

**Overview:**Gallagher Bassett, a multinational claims services provider, seeks licensed Filipino nurses to join their Makati City team.This role supports utilization management (UM) teams by processing requests and verifying treatments for workers' compensation (WC) claims.**Key Responsibilities:**Accurately enter data, including CPT and ICD-10 codes, into...

Get AI-powered advice on this job and more exclusive features.Direct message the job poster from Epic Healthcare Staffing Shared Services, Inc.The Credentialing Specialist is responsible for all aspects of initial credentialing, recredentialing, and if applicable privileging of clinicians and/or providers within credentialing scope who are employed or...

As a Credentialing Specialist at Epic Healthcare Staffing Shared Services, Inc., you will be responsible for all aspects of initial credentialing, recredentialing, and privileging of clinicians and providers.You will collect and verify sensitive provider data, assess and evaluate application information, and communicate with relevant parties to ensure...

Key ResponsibilitiesAs a Clinical Audit Specialist at ISTA Solutions, your key responsibilities include:Clinical Review & Auditing: Audit clinical records and documentation to ensure they meet standards for authorization and billing.Collaborate with Healthcare Providers: Work closely with healthcare teams, administrators, and other stakeholders to ensure...

If you're passionate about delivering exceptional customer service and making a difference in the lives of others, consider joining our team as a Customer Experience Specialist in Healthcare.About the RoleThis exciting opportunity will allow you to utilize your excellent communication and interpersonal skills to provide top-notch support to patients and...