Clinical Care Manager- Utilization Review - Chicago

This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity. · ...

A Utilization Review Nurse will perform medical reviews of claims suspended for medical necessity using medically accepted criteria. · ...

+ Utilization Review Specialists bridge between a Utilization Review Nurse and Pre-Clinical Coordinator + Facilitate and schedule appointments as needed + Maintain appropriate electronic and paper files + Interface with inter-disciplinary providers + Basic invoicing at completion ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · 3 years clinical experience with 2 years' experience in utilization rev ...

This position performs medical review of claims suspended for medical necessity using medically accepted criteria. · Candidates must reside in TX or IL · ...

This position is responsible for ensuring compliance of the Utilization Management (UM) and Quality Review (QR) functions performed by the Medical Groups/IPAs participating in the networks of client's HMOs. · ...

+Job summary · Lensa does not hire directly for these jobs but promotes them on behalf of its direct clients. · +Reviews documentation and evaluates Potential Quality of Care issues based on clinical policies and benefit determinations. · Evaluates documentation/information to de ...

This position is responsible for ensuring accurate and timely clinical review of behavioral health cases for medical necessity including assisting members on the telephone reviewing medical records reviewing cases which involve contract interpretation of behavioral health diagnos ...

We're looking for a Utilization Review Coordinator who truly understands the substance use disorder treatment world and how payors work. · In this role, you'll be a key bridge between our clinical team and payors, making sure our clients get – and keep – the right level of care a ...

+The Medical Director is responsible for the overall quality, effectiveness and coordination of medical review services. · +Conduct coverage reviews based on individual member plan benefits and national and proprietary coverage review policies. · Renderecoverage determinations. · ...

We are looking for a Utilization Review Specialist to join our team The Utilization Review Specialist bridges between a Utilization Review Nurse and Pre-Clinical Coordinator providing coverage for both teams. · The full UR function can be performed in applicable jurisdictions. UR ...

We are looking for a Utilization Review Specialist to join our team The Utilization Review Specialist bridges between a Utilization Review Nurse and Pre-Clinical Coordinator providing coverage for both teams. · Initiate and maintain appropriate verbal and/or written contacts with ...

Coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery. · ...

This Utilization Review Nurse will coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery. · ...

Coordinate and perform all aspects of Worker's Compensation, auto, and general liability claims for medical management activity (IME/Peer Review, UR) to ensure optimum medical care service delivery. · ...

We are looking for motivated, dependable, and dedicated caregivers to provide exceptional direct care and support to our patients. The Utilization Review Coordinator is responsible for overseeing the Utilization Review Program.This includes the implementation of case management s ...

We are looking for motivated, dependable and dedicated caregivers to provide exceptional direct care and support to our patients. The Utilization Review Coordinator is responsible for overseeing the Utilization Review Program. · ...

+Assumes responsibility and accountability for the appropriate utilization of facilities and services. Coordinates total care given by interdisciplinary team members and directs them to provide and facilitate optimal health care/discharge planning. · +Bachelor's degree in healthc ...

We are seeking a Clinical Care Manager who is passionate about advancing high-quality, compliant, patient-centered care through precise and timely Utilization Review. · Complete timely review of healthcare services using appropriate medical criteria to support determinations. · D ...

The ED Utilization Review/Case Manager is responsible for facilitating the appropriate use of hospital resources by ensuring that the patient meets acute inpatient criteria, and anticipates and provides assistance with discharge needs in a timely fashion. · This position is a cen ...