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MRIoANew
Overview
The role involves conducting independent Utilization Reviews for oncology cases. It requires adherence to HIPAA regulations and company policies regarding sensitive health information.
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Compensation
Salary not listed
Posted
New
The physician will conduct independent Utilization Reviews in Oncology. This role requires only 1-2 hours of work per week.
The role involves conducting independent Utilization Reviews for Endocrinology. It requires only 1-2 hours of work per week with no minimum commitment.
Board-Certified physicians in Vascular Surgery are sought to conduct independent Utilization Reviews for the organization. This role requires adherence to all applicable HIPAA regulations and company policies regarding sensitive health information.
Conduct independent Utilization Reviews as a Board-Certified physician in Rheumatology. The role requires adherence to HIPAA regulations and company policies regarding sensitive health information.
The physician will conduct independent Utilization Reviews in Rheumatology. This role requires only 1-2 hours of work per week.
Lifepoint Health
Facilitates clinical reviews for patient admissions and continued stays to determine the legitimacy of treatment and length of stay. Interfaces with managed care organizations and payers to secure insurance coverage and advocate for necessary patient treatment.
$33 - $45 / HOUR
3 days ago
OSF HealthCare
The specialist evaluates patient care and admission status against objective criteria to ensure medical necessity. They identify and resolve utilization issues regarding the over or under-utilization of hospital services.
4 days ago
Centene Corporation
Conducts clinical reviews and prior authorizations for mental health and substance abuse services to ensure medical appropriateness. Monitors inpatient stays and collaborates with providers and medical directors to optimize care quality and efficiency.
$27 - $49 / HOUR
NeueHealth
The PA Nurse evaluates prior authorization requests for treatments and procedures to ensure alignment with medical necessity criteria and coverage policies. They act as a liaison between providers, patients, and health plans while documenting all activities in EMR systems.
$27 - $41 / HOUR
5 days ago
The Utilization Management Nurse evaluates and processes prior authorization requests for medical procedures, medications, and services to ensure clinical appropriateness. They also collaborate with medical directors and healthcare providers to facilitate coverage decisions and maintain compliance with regulatory standards.
$74,260 - $111,391 / YEAR
Gainwell Technologies LLC
The Utilization Review Nurse will conduct reviews for medical necessity and appropriateness of services, ensuring compliance with clinical criteria and policies. This includes engaging with providers, documenting findings, and assisting in training new nurses.
$65,000 - $78,000 / YEAR
6 days ago
L.A. Care Health Plan
The Utilization Management Nurse Specialist RN II facilitates, coordinates, and approves medically necessary referrals, ensuring timely determination and notification of referral statuses, and generates necessary approval or denial communications. This role also involves performing telephonic and/or onsite admission and concurrent review, collaborating on discharge plans, and monitoring inpatient admissions.
$88,854 - $142,166 / YEAR
7 days ago
Emory Healthcare
Conduct medical necessity reviews for inpatient and observation admissions using Milliman and Interqual guidelines to ensure appropriate status designation. Coordinate with physicians and payers to maximize reimbursement and reduce financial risk through timely communication and documentation.
8 days ago
Inova
The Case Management Specialist coordinates administrative activities to support the department, including participating in budget processes and arranging necessary continuing care services like Home Health and SNF for patient transitions. This role also involves communicating and documenting accurate clinical and financial information to support assessments and evaluations of patient needs.
10 days ago
Acadia
The role involves monitoring patient service utilization to optimize facility reimbursement and acting as a liaison between managed care organizations and clinical staff. Key duties include conducting medical necessity reviews, managing the appeal process for denied stays, and providing staff training on documentation requirements.
11 days ago
MONARCH
Acts as the primary contact for crisis services, managing screenings, referrals, and medical necessity documentation for youth. Collaborates with interdisciplinary teams to determine service eligibility and ensures adherence to state and federal regulations.
$22 / HOUR
14 days ago
Serves as the primary contact for crisis services, managing screenings, referrals, and medical necessity documentation for youth. Coordinates with interdisciplinary teams and payors to ensure service authorization and adherence to regulatory guidelines.
Serves as the primary contact for crisis services, managing screenings, referrals, and the determination process for youth. Responsible for establishing medical necessity and obtaining prior authorizations to justify services to payors.
MRIoA
The Radiologist will conduct independent Utilization Reviews. This role requires adherence to HIPAA regulations and company policies regarding sensitive health information.
