Director of Clinical Utilization Review - Nashville, TN

Registered Nurse Utilization Management is responsible for collaborating with healthcare providers and members to optimize member benefits and promote effective use of resources. · ...

Job Summary · The Manager of Utilization Review oversees a team of utilization review nurses and coordinators to ensure compliance with clinical regulatory standards and optimize patient care. · ...

The Manager of Utilization Review oversees a team of utilization review nurses and coordinators ensuring compliance with clinical regulatory standards enhancing the overall utilization review process to optimize patient care and manage resources effectively. · Serves as escalatio ...

Job summaryThe Manager of Utilization Review oversees a team of utilization review nurses and coordinators, ensuring compliance with clinical regulatory standards, and enhancing the overall utilization review process to optimize patient care and manage resources effectively. · ...

The Consolidated Patient Accounts Center (CPAC) is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions - and the integration of VHA and industry best standards. · The Reve ...

The Consolidated Patient Accounts Center (CPAC) is a regionally consolidated business entity established to enhance revenue operations throughout the VHA network by standardization and consolidation of functions, · English Language Proficiency. · ...

The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. · This role conducts admission and continued stay reviews, supports denials and ...

The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. · ...

+The Clinical Utilization Review Specialist is responsible for evaluating the necessity, appropriateness, and efficiency of hospital services to ensure compliance with utilization management policies. · +Performs admission and continued stay reviews using evidence-based criteria, ...

The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. · ...

We help clients navigate complexity, support recovery and deliver outcomes that make a real difference in people's lives. · ...

Nurse Consultant Utilization Review provides utilization management review of worker's compensation claims accessing medical documentation and information provided by medical providers to determine the appropriateness of treatment setting and length of treatment required communic ...

The Utilization Review Nurse is to assess the medical necessity and quality of healthcare services by conducting pre-service, concurrent, and retrospective utilization management reviews. · ...

The Customer Support Technician III provides advanced design and planning of desktop and telecom services. · Support the mentoring and training of assigned persons in execution of Service Desk activities. · Establish standards for PC utilization, backup techniques, · & security. ...

The OASIS Reviewer is responsible for analyzing the data integrity and consistency of OASIS documentation and assessment processes. · ...

The Sr. Project Manager oversees project Safety Quality and all Project Controls to lead projects up to $200+ million dollars. · The PM is accountable for all aspects of the project including but not limited to safety quality labor material scope client interaction and overall ex ...

· The Sr. Project Manager can run a standalone multi-craft, joint venture, or EPC project up to $200+ million dollars. ...

The Utilization Specialist proactively monitors utilization of services for patients to optimize reimbursement for the facility. · ...

The Quality Operator performs handset inspections to verify product compliance to Asurion's documented standards. They utilize DAX, databases, and spreadsheets to record ESNs, inspection results, and information. · Perform handset inspection to verify product compliance to Asurio ...

BlueCross BlueShield of South Carolina is hiring an Appeals Analyst to research and analyze complex appeals and retrospective review requests.Research the substance of service appeals by both member and provider based on clinical documentation. · Perform thorough research of appe ...