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 ...
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 ...
Credit Review Officer
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Credit Review Officer
Columbus, OH · On-site
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Credit Review Officer
Columbus, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Credit Review Officer
Columbus, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Credit Review Officer
Powell, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Credit Review Officer
Powell, OH · On-site +1
Performs and/or assists with credit reviews for quality, accuracy, and compliance with regulations, seeking guidance from senior staff or management when necessary. Conducts independent detailed ...
Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical ...
Utilization Review Specialist
Columbus, OH · On-site
Utilization Review Specialist Job Summary: The Utilization Review (UR) Specialist is responsible for ensuring that clients receiving substance use disorder (SUD) treatment services meet clinical ...
Previous utilization review experience in a psychiatric healthcare facility preferred. License: Current unencumbered clinical license strongly preferred. Additional Requirements: CPR certification ...
Previous utilization review experience in a psychiatric healthcare facility preferred. License: Current unencumbered clinical license strongly preferred. Additional Requirements: CPR certification ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre ...
Reviews behavioral health cases to determine medical necessity and appropriateness of care, ensuring compliance with established guidelines and policies. Performs pre-certifications, pre ...
De Novo, a boutique staffing and recruitment agency, is currently seeking a personal injury attorney with discovery review experience to work directly with one of our clients. This is a contract to ...
Quick apply
De Novo, a boutique staffing and recruitment agency, is currently seeking a personal injury attorney with discovery review experience to work directly with one of our clients. This is a contract to ...
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
Conducts prior authorization reviews to determine financial responsibility Qualifications * 2 years Inpatient background with Hospital Nursing (Med-Surg, ER) * Well versed in Utilization Management ...
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 ...
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 ...
Care Review Processor
Columbus, OH · On-site
Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Members that require hospitalization and/or utilization review for other healthcare services
Care Review Processor
Columbus, OH · On-site
Works within the Care Access and Monitoring (CAM) team to provide clerical and data entry support for Members that require hospitalization and/or utilization review for other healthcare services
De Novo, a boutique staffing and recruitment agency is currently seeking a Discovery Review Contract Attorney with experience in the area of personal injury and/or mass tort/class action to work ...
Quick apply
De Novo, a boutique staffing and recruitment agency is currently seeking a Discovery Review Contract Attorney with experience in the area of personal injury and/or mass tort/class action to work ...
FCIRR Centralized Review Team - Reviewer 1
Columbus, OH · On-site
$66K - $78K/yr
Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an ...
FCIRR Centralized Review Team - Reviewer 1
Columbus, OH · On-site
$66K - $78K/yr
Partners with their assigned Line of Business, other Risk/Compliance/Audit (RCA) professionals, and RCA Managers to, depending on their function, create, implement, maintain, review or oversee an ...
Credit Review Specialist - Commercial
Columbus, OH · On-site +1
$63K - $124K/yr
The Credit Review Specialist (CRS) - Commercial will report to a Commercial Credit Review Team Lead and perform activities to evaluate the credit risk embedded in Bank assets. The candidate will ...
Credit Review Specialist - Commercial
Columbus, OH · On-site +1
$63K - $124K/yr
The Credit Review Specialist (CRS) - Commercial will report to a Commercial Credit Review Team Lead and perform activities to evaluate the credit risk embedded in Bank assets. The candidate will ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
This position is responsible for reviews of third-party appraisal reports for Commercial lending. This individual will provide superior service to the bank's Customers, Commercial business line ...
Overdose Fatality Review Coordinator
$30.24 - $35.53/hr
NOW HIRING: Overdose Fatality Review Team Coordinator Under supervision from the Prevention and Education Supervisor, the OFR Team Lead will work in support of Franklin County's efforts to ...
Overdose Fatality Review Coordinator
$30.24 - $35.53/hr
NOW HIRING: Overdose Fatality Review Team Coordinator Under supervision from the Prevention and Education Supervisor, the OFR Team Lead will work in support of Franklin County's efforts to ...
Overdose Fatality Review Coordinator
Columbus, OH · On-site
$30.24 - $35.53/hr
NOW HIRING: Overdose Fatality Review Team Coordinator Under supervision from the Prevention and Education Supervisor, the OFR Team Lead will work in support of Franklin County's efforts to ...
Overdose Fatality Review Coordinator
Columbus, OH · On-site
$30.24 - $35.53/hr
NOW HIRING: Overdose Fatality Review Team Coordinator Under supervision from the Prevention and Education Supervisor, the OFR Team Lead will work in support of Franklin County's efforts to ...
Care Review Processor I
Columbus, OH · On-site
Title : Care Review Processor Location : Columbus, OH Duration : 3+ Months Responsibilities : Temp for 90 days, no possibility of going permanent. M-F 8 am to 5 pm, no OT. Building case prior ...
Care Review Processor I
Columbus, OH · On-site
Title : Care Review Processor Location : Columbus, OH Duration : 3+ Months Responsibilities : Temp for 90 days, no possibility of going permanent. M-F 8 am to 5 pm, no OT. Building case prior ...
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Job description
Company Description
Integrated Resources, Inc., is led by a seasoned team with combined decades in the industry. We deliver strategic workforce solutions that help you manage your talent and business more efficiently and effectively. Since launching in 1996, IRI has attracted, assembled and retained key employees who are experts in their fields. This has helped us expand into new sectors and steadily grow.
We've stayed true to our focus of finding qualified and experienced professionals in our specialty areas. Our partner-employers know that they can rely on us to find the right match between their needs and the abilities of our top-tier candidates. By continually exceeding their expectations, we have built successful ongoing partnerships that help us stay true to our commitments of performance and integrity.
Our team works hard to deliver a tailored approach for each and every client, critical in matching the right employers with the right candidates. We forge partnerships that are meant for the long term and align skills and cultures. At IRI, we know that our success is directly tied to our clients' success.
Job Description
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
BackgroundÂ
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)Â
Potential for longer term dependent on enrollmentÂ
Workers will be doing Concurrent Inpatient ReviewÂ
MUST have one of the following AT LEASTÂ
-Utilization Review in hospital settingÂ
Nurses who are used to doing both production and review work
Additional Information
All your information will be kept confidential according to EEO guidelines.
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