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Insurance Utilization Review Slp Jobs (NOW HIRING)

Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...

Obtain initial and concurrent insurance authorizations for all levels of care. * Review clinical ... Participate in utilization review meetings and case conferences. * Generate reports on ...

Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past ...

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Tampa, FL · On-site

$59K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Wayne, PA · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

Utilization Reviewer 2

Saint Louis, MO · On-site

$52K - $76K/yr

Prior review experience in healthcare, insurance, utilization management, quality assurance, or other applicable capacity. * Prior experience in the workers' compensations field. Benefits We're ...

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Care Review Nurse

Columbus, OH • On-site

Integrated Resources
Recruiting and Staffing Services • 51 - 200 employees

Other

Re-posted 2 days ago


Job description

Care Review Nurse

Works with the Utilization Management team primarily responsible for inpatient medical necessity/utilization review and other utilization management activities aimed at providing Healthcare members with the right care at the right place at the right time. Provides daily review and evaluation of members that require hospitalization and/or procedures providing prior authorizations and/or concurrent review. Assesses services for Members to ensure optimum outcomes, cost effectiveness and compliance with all state and federal regulations and guidelines.

Medicaid Division

Duties: Review cases for in patients/in hospital: skilled care, acute rehab and long term acute care Nurses working at the facilities Members are being care for, will be sending over clinical information to be reviewed by the Care Review Clinician. Therefore, this agent will not be traveling and will be reviewing information at the office.

Qualifications: Background Hospital Utilization Management. Insurance Utilization Manager/Review and Millemen Experience (MCG). No case managers if that is their only experience. Must have Utilization Review or Management. Utilization Review (1 year +), Past hospital experience (3-4 years of experience, less experience is ok if they have more Utilization Review experience) Potential for longer term dependent on enrollment Workers will be doing Concurrent Inpatient Review MUST have one of the following AT LEAST -Utilization Review in hospital setting Nurses who are used to doing both production and review work

All your information will be kept confidential according to EEO guidelines.


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About Integrated Resources

Sourced by ZipRecruiter

Integrated Resources Inc (IRI), based in Edison, NJ, US, is an esteemed player in the staffing solutions industry with a credible presence on their official website irionline.com. Notably, IRI provides a range of professional staffing services including contract, contract-to-hire, and direct hire solutions to a wide spectrum of industries such as healthcare, life sciences, manufacturing, financial, insurance, and others. Since its inception, IRI has been committed to delivering top-talent and optimum solutions to meet its clients' diverse needs.

Industry

Recruiting and staffing services

Company size

51 - 200 Employees

Headquarters location

Edison, NJ, US

Year founded

1996